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General NPI Number Information
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NPI Number | 1114008737
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Entity Type | Organization
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Legal Business Name | ADVANCED MEDICAL IMAGING CENTER LLC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16821 SE MCGILLIVRAY BLVD
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City | VANCOUVER
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State | WA
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Zip | 98683-0499
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Country | US
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Telephone | 360-883-0885
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Fax | 360-883-0071
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Provider Business Mailing Address
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Address Line | 16821 SE MCGILLIVRAY BLVD
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City | VANCOUVER
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State | WA
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Zip | 98683-0499
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Country | US
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Telephone | 360-883-0885
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Fax | 360-883-0071
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. QUENTIN PHILLIPS II
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Credential |
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Telephone | 360-883-0885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | WA
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