=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265979405
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED DIAGNOSTIC IMAGING, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2017
-----------------------------------------------------
Last Update Date | 01/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4230 HARDING PIKE SUITE 503
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37205-2013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-964-5864
-----------------------------------------------------
Fax | 615-386-2399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3024 BUSINESS PARK CIR
-----------------------------------------------------
City | GOODLETTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37072-3132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-851-6033
-----------------------------------------------------
Fax | 615-851-2018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHAD L CALENDINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 615-356-3999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------