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General NPI Number Information
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NPI Number | 1437493376
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Entity Type | Organization
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Legal Business Name | AMERICAN DIAGNOSTIC IMAGING LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 3937 SHERMAN AVE
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3649
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Country | US
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Telephone | 816-676-0625
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Fax |
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Provider Business Mailing Address
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Address Line | 4160 CHEROKEE ST NW
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City | KENNESAW
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State | GA
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Zip | 30144-1279
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Country | US
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Telephone | 770-241-7071
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATT MASODY
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Credential |
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Telephone | 770-241-7071
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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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