Organization
ADVANCED DIAGNOSTIC IMAGING LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID MARTIN MD (PRESIDENT)
(618) 257-9567
Entity
Organization
Contact information
Practice address
4500 MEMORIAL DR, DEPT OF RADIOLOGY, BELLEVILLE, IL 62226-5360
(618) 257-9567
Mailing address
PO BOX 662, EDWARDSVILLE, IL 62025-0662
(405) 947-5557
(405) 948-6507
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180930
BCBS OF MO
MO
01
—
8232083
BCBS OF IL
IL
Enumeration date
06/18/2006
Last updated
04/17/2008
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