MEDICARE: ADVANCED DIAGNOSTICS, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2471S1302X	Sonography Radiologic Technologist
2	2471V0105X	Vascular Sonography Radiologic Technologist
3	246XS1301X	Sonography Specialist/Technologist Cardiovascular

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	:	1487652442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	1 WELLNESS BLVD STE 105
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2872
Country	:	US
Telephone Number	:	803-419-4235
Fax Number	:	803-419-4236

Provider Business Practice Location Address
First Line	:	1 WELLNESS BLVD STE 105
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2872
Country	:	US
Telephone Number	:	803-419-4235
Fax Number	:	803-419-4236

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DANIEL P BOUKNIGHT
Credential	:	MD
Telephone Number	:	803-888-2282

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	06/27/2022

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Directions to “ADVANCED DIAGNOSTICS, INC. ” Practice Location

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