Provider Demographics
NPI:1588499040
Name:ADVANCED IMAGING RENO
Entity type:Organization
Organization Name:ADVANCED IMAGING RENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-413-3263
Mailing Address - Street 1:5420 KIETZKE LN STE 209
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2062
Mailing Address - Country:US
Mailing Address - Phone:775-507-3331
Mailing Address - Fax:775-540-5988
Practice Address - Street 1:5420 KIETZKE LN STE 108
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2063
Practice Address - Country:US
Practice Address - Phone:775-507-3331
Practice Address - Fax:775-540-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty