1487657433 NPI number — PEKIN MRI, LLC

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:	PEKIN MRI, LLC
Provider Last Name (Legal Name)	:
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NPI Number	:	1487657433
Entity Type Code	:	Organization
Replacement NPI	:
Last Update Date	:	04/20/2008
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Provider First Line Business Mailing Address	:	1894 GEORGETOWN RD
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	HUDSON
Provider Business Mailing Address State Name	:	OH
Provider Business Mailing Address Postal Code	:	442364058
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	3306533968
Provider Business Mailing Address Fax Number	:	3306561660

Provider First Line Business Practice Location Address	:	1300 PARK AVE
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	PEKIN
Provider Business Practice Location Address State Name	:	IL
Provider Business Practice Location Address Postal Code	:	615545038
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	3093472143
Provider Business Practice Location Address Fax Number	:	3093472416
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:	COYNE
Authorized Official First Name	:	V.
Authorized Official Middle Name	:	RENAE
Authorized Official Title or Position	:	DIRECTOR OF BILLING
Authorized Official Telephone Number	:	3306533968

• Taxonomy code: 293D00000X .

• Identifier: =========001 , issued by the state of ( IL ) . This identifiers is of the category "".
• Identifier: 200561 , issued by the state of ( IL ) . This identifiers is of the category "".