MEDICARE: ADVANCED DIAGNOSTIC IMAGING PC

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487793006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DIAGNOSTIC IMAGING PC

Provider Business Mailing Address
First Line	:	1120 PROFESSIONAL BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-8000
Country	:	US
Telephone Number	:	812-471-7086
Fax Number	:	812-471-3381

Provider Business Practice Location Address
First Line	:	1033 E MOUNT PLEASANT RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47725-7149
Country	:	US
Telephone Number	:	812-867-2492
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DEBBIE L. COLLINS
Credential	:
Telephone Number	:	812-475-0765

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	09/30/2009

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