MEDICARE: ADVANCED DIAGNOSTIC SERVICES, 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	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1760626535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DIAGNOSTIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	235 NE 1ST ST
Second Line	:	PH 7
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3783
Country	:	US
Telephone Number	:	512-810-8002
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 NE 1ST ST
Second Line	:	PH 7
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3783
Country	:	US
Telephone Number	:	512-810-8002
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MARK NOWLAN
Credential	:
Telephone Number	:	512-810-8002

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	05/29/2009

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