Provider Demographics
NPI:1386698934
Name:ADVANCED TECH DIAGNOSTIC CENTER INC
Entity type:Organization
Organization Name:ADVANCED TECH DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FERMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-4221
Mailing Address - Street 1:352 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3031
Mailing Address - Country:US
Mailing Address - Phone:305-646-8212
Mailing Address - Fax:305-649-4483
Practice Address - Street 1:352 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3031
Practice Address - Country:US
Practice Address - Phone:305-646-8212
Practice Address - Fax:305-649-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5071261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8724Medicare PIN