Organization
ADVANCED MEDICAL IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK L MATTI MD (PRESIDENT)
(307) 352-8384
Entity
Organization
Contact information
Practice address
1200 COLLEGE DR, ROCK SPRINGS, WY 82901-5868
(786) 621-3900
Mailing address
PO BOX 912853, DENVER, CO 80291-2853
(786) 621-3900
(405) 948-6507
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06012001
BCBS OF WY
—
05
—
123400500
—
WY
01
—
612454200
DEPT OF LABOR
—
Enumeration date
09/27/2006
Last updated
02/14/2022
Update your record
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