MEDICARE: ADVANCED IMAGING CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center	1996061345	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033112990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED IMAGING CENTER LLC

Provider Business Mailing Address
First Line	:	7860 BURR ST
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375
Country	:	US
Telephone Number	:	219-864-2900
Fax Number	:	219-864-2910

Provider Business Practice Location Address
First Line	:	7860 BURR ST
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375
Country	:	US
Telephone Number	:	219-864-2900
Fax Number	:	219-864-2910

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SHODHAN L PATEL
Credential	:	MD
Telephone Number	:	219-864-2900

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	02/24/2009

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Directions to “ADVANCED IMAGING CENTER LLC ” Practice Location

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