MEDICARE: AMERICAN DIAGNOSTIC SERVICES, 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	2471S1302X	Sonography Radiologic Technologist

General Provider Information

NPI Number	:	1356582910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DIAGNOSTIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	22285 N PEPPER RD STE 105
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2539
Country	:	US
Telephone Number	:	847-382-1728
Fax Number	:

Provider Business Practice Location Address
First Line	:	22285 N PEPPER RD STE 105
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2539
Country	:	US
Telephone Number	:	847-382-1728
Fax Number	:

Authorized Official
Title or Position	:	C.E.O.
Name	:	MR. GARY LEE COLLETT
Credential	:	RDMS
Telephone Number	:	847-382-1728

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	03/11/2009

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