1861408213 NPI number — RADIOLOGY IMAGING SPECIALISTS

Table of content: (NPI 1861408213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861408213 NPI number — RADIOLOGY IMAGING SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY IMAGING SPECIALISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861408213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6910 S MADISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLOWBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60527-5504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-321-2727
Provider Business Mailing Address Fax Number:
630-323-1699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 W 95TH ST
Provider Second Line Business Practice Location Address:
LITTLE COMPANY OF MARY HOSPITAL
Provider Business Practice Location Address City Name:
EVERGREEN PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60805-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-229-5104
Provider Business Practice Location Address Fax Number:
630-323-1699
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SARKA
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
630-928-5234

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022154 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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