MEDICARE: ADVANCED 3D IMAGING, 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	:	1932495959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED 3D IMAGING, LLC

Provider Business Mailing Address
First Line	:	835 7TH ST
Second Line	:	SUITE 6B
City	:	CLERMONT
State	:	FL
Zip	:	34711-2190
Country	:	US
Telephone Number	:	352-404-5112
Fax Number	:	888-498-5550

Provider Business Practice Location Address
First Line	:	835 7TH ST
Second Line	:	SUITE 6B
City	:	CLERMONT
State	:	FL
Zip	:	34711-2190
Country	:	US
Telephone Number	:	352-404-5112
Fax Number	:	888-498-5550

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER CHEN
Credential	:
Telephone Number	:	352-404-5112

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	06/29/2011

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