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General NPI Number Information
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NPI Number | 1275870420
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Entity Type | Organization
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Legal Business Name | RADADVANTAGE ILLINOIS, P.C.
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 3805 E BELL RD SUITE 5500
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City | PHOENIX
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State | AZ
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Zip | 85032-2105
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Country | US
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Telephone | 602-910-6887
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Fax | 602-635-1262
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Provider Business Mailing Address
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Address Line | 1351 4TH ST SUITE 300
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City | SANTA MONICA
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State | CA
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Zip | 90401-1337
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Country | US
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Telephone | 310-869-4148
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Fax | 847-854-6725
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Authorized Official
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Title or Position | VICE PRESIDENT, OPERATIONS
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Name | MR. BRIAN HALL
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Credential |
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Telephone | 602-910-6887
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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 |
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