Advanced Physicians, S.C.

Organization Active NPI Diagnostic Radiology Physician · Crest Hill, IL

NPI 1467409490 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1467409490
Entity type
Organization (NPI type 2)
Primary specialty
Diagnostic Radiology Physician 2085R0202X
Legal business name
ADVANCED PHYSICIANS, S.C.
Practice address
16101 Weber Rd
Crest Hill, IL 60435-8742
Phone
(815) 836-3788
Fax
(815) 836-8784
NPI assigned
May 27, 2006
Organization subpart
No

Authorized official

Name
Dr. Dana M. Vallandigham, D.C. NPI 1780631481
Title
President
Phone
(630) 789-3338

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20051111000170 IL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 6103879713 Practice locations: Crest Hill, IL

National Provider Directory

Tax ID family
Advanced Physicians SC (2 organizations share this tax ID)

Locations

16101 Weber Rd
Crest Hill, IL 60403
Phone (815) 306-1100

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician
Group: 193200000X MULTI-SPECIALTY GROUP
2085R0202X Yes

Addresses

Primary practice location

16101 Weber Rd
Crest Hill, IL 60435-8742

Mailing address

6300 Kingery Hwy
Suite 404
Willow Brook, IL 60527-2248
Phone (630) 789-3338

Other providers in Crest Hill, IL

All providers in Crest Hill, IL · Diagnostic Radiology Physician in Illinois

Sources for this page

Verify at the official NPI Registry.