MEDICARE: ADVANCED RADIOLOGY OF JEFFERSON CITY, 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1568621175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED RADIOLOGY OF JEFFERSON CITY, LLC

Provider Business Mailing Address
First Line	:	3218 W EDGEWOOD DR STE 200
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6951
Country	:	US
Telephone Number	:	573-635-6262
Fax Number	:	573-635-9786

Provider Business Practice Location Address
First Line	:	3218 W EDGEWOOD DR STE 200
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6951
Country	:	US
Telephone Number	:	573-635-6262
Fax Number	:	573-635-9786

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	ALAN HILLARD
Credential	:	M.D.
Telephone Number	:	573-442-1788

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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