Organization
ADVANCED DIAGNOSTIC RADIOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN P MORADIAN MD (PRESIDENT)
(208) 557-0999
Entity
Organization
Contact information
Practice address
1301 15TH AVE W, WILLISTON, ND 58801-3821
(701) 774-7401
Mailing address
PO BOX 2537, WILLISTON, ND 58802-2537
(866) 338-6472
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149528
BLUE SHIELD NUMBER
ID
05
—
15040
—
ND
05
—
807083700
—
ID
01
—
8M916
BC OF IDAHO
UT
01
—
IF - 8L493
BC NUMBER - IDAHO FALLS
ID
01
—
POC - 8L501
BC NUMBER FOR POCATELLO
ID
Enumeration date
07/08/2005
Last updated
10/17/2008
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