Provider Demographics
NPI:1063958718
Name:ADVANCED DIAGNOSTIC IMAGING, PC
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTIC IMAGING, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALENDINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-356-3999
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:301 TYSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4544
Practice Address - Country:US
Practice Address - Phone:731-642-1220
Practice Address - Fax:615-269-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3372986Medicaid
TN3372986Medicare PIN