MEDICARE: AMERICA MEDICAL IMAGING CENTER, INC.

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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1603015574	OTHER	CA	DRIVER LICENSE

General Provider Information

NPI Number	:	1144559469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICA MEDICAL IMAGING CENTER, INC.

Provider Business Mailing Address
First Line	:	500 E OLIVE AVE STE 103
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91501-2171
Country	:	US
Telephone Number	:	818-861-7902
Fax Number	:	818-861-7385

Provider Business Practice Location Address
First Line	:	500 E OLIVE AVE STE 103
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91501-2171
Country	:	US
Telephone Number	:	818-861-7902
Fax Number	:	818-861-7385

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALEXANDER ASTAFIEV
Credential	:
Telephone Number	:	818-861-7902

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	03/01/2021

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