Provider Demographics
NPI:1679799811
Name:ALLIED DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:ALLIED DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-926-5396
Mailing Address - Street 1:3838 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3110
Mailing Address - Country:US
Mailing Address - Phone:574-968-4100
Mailing Address - Fax:574-968-4125
Practice Address - Street 1:3838 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3110
Practice Address - Country:US
Practice Address - Phone:574-968-4100
Practice Address - Fax:574-968-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF70565Medicare UPIN