Provider Demographics
NPI:1356582910
Name:AMERICAN DIAGNOSTIC SERVICES, INC.
Entity type:Organization
Organization Name:AMERICAN DIAGNOSTIC SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:847-382-1728
Mailing Address - Street 1:22285 N PEPPER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2539
Mailing Address - Country:US
Mailing Address - Phone:847-382-1728
Mailing Address - Fax:
Practice Address - Street 1:22285 N PEPPER RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2539
Practice Address - Country:US
Practice Address - Phone:847-382-1728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6019701Medicaid
IL561510Medicare PIN