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NPI Code Detail

MEDICARE: ADVANCED IMAGING S.C.

MEDICARE: ADVANCED IMAGING S.C.
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
1261QR0200XRadiology Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1073592473
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED IMAGING S.C.
Provider Business Mailing Address
First Line : 228 S 18TH AVE
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1000
Country : US
Telephone Number : 920-746-9729
Fax Number : 920-746-9881
Provider Business Practice Location Address
First Line : 228 S 18TH AVE
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1000
Country : US
Telephone Number : 920-746-9729
Fax Number : 920-746-9881
Authorized Official
Title or Position : PRESIDENT
Name : KURT G HARRIS
Credential : M.D.
Telephone Number : 920-746-9729
Provider Enumeration Date : 01/13/2006
Last Update Date : 08/22/2020

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1780292763 — DR. MICHELLE KATHLEEN SHIPP DDS
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Practice Fax:
1770195810 — PATRICK THOMAS BERG DDS
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1417764986 — JEANETTE PAHL
Practice Location Address:
228 S 18TH AVE
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Practice Fax: 920-743-3340

Directions to “ADVANCED IMAGING S.C. ” Practice Location

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