Provider Demographics
NPI:1174604334
Name:ADVANCED RADIOLOGIC PHYSICIANS, INC.
Entity type:Organization
Organization Name:ADVANCED RADIOLOGIC PHYSICIANS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-354-8960
Mailing Address - Street 1:3455 MILL RUN DR.
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9083
Mailing Address - Country:US
Mailing Address - Phone:614-771-2229
Mailing Address - Fax:614-771-2248
Practice Address - Street 1:950 W. WOOSTER ST.
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2603
Practice Address - Country:US
Practice Address - Phone:419-354-8960
Practice Address - Fax:419-354-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2117604Medicaid
OH2115688Medicaid
OH2522336Medicaid
OH0200900Medicaid
OH2190838Medicaid
FL9123890 00Medicaid
OH8759884Medicaid
OH2115688Medicaid
OH2190838Medicaid
FL9123890 00Medicaid
OH0200900Medicaid
OH9304731Medicare PIN