MEDICARE: ADVANTAGE IMAGING SOLUTIONS, LLC

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	:	1558667733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE IMAGING SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	220 FORBES RD
Second Line	:	SUITE 304
City	:	BRAINTREE
State	:	MA
Zip	:	02184-2705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 FORBES RD
Second Line	:	SUITE 304
City	:	BRAINTREE
State	:	MA
Zip	:	02184-2705
Country	:	US
Telephone Number	:	617-943-1812
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	CHERIS HERSEY
Credential	:
Telephone Number	:	617-943-1812

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	02/04/2011

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