Provider Demographics
NPI:1073591681
Name:ADVANCED RADIOLOGY IMAGING ASSOCIATES LLC
Entity type:Organization
Organization Name:ADVANCED RADIOLOGY IMAGING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAURIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-454-2742
Mailing Address - Street 1:13300-56 S. CLEVELAND AVE
Mailing Address - Street 2:PMB # 239
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7150
Mailing Address - Country:US
Mailing Address - Phone:239-454-2742
Mailing Address - Fax:239-466-2742
Practice Address - Street 1:13731 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7150
Practice Address - Country:US
Practice Address - Phone:239-454-2742
Practice Address - Fax:239-466-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201956300Medicaid
FLDE1300OtherGROUP RAILROAD NUMBER
FLK9008Medicare ID - Type Unspecified