MEDICARE: ADVANCED IMAGING SPECIALISTS, 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	261QR0200X	Radiology Clinic/Center		IL

General Provider Information

NPI Number	:	1336369875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED IMAGING SPECIALISTS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 7389
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-7389
Country	:	US
Telephone Number	:	773-774-6440
Fax Number	:	773-774-4372

Provider Business Practice Location Address
First Line	:	5318 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4108
Country	:	US
Telephone Number	:	773-774-6430
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GEORGE NELLA
Credential	:
Telephone Number	:	773-774-6440

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	06/30/2009

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