1730632209 NPI number — PREFERRED OPEN MRI LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730632209 NPI number — PREFERRED OPEN MRI LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED OPEN MRI LTD
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:
6
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:
1730632209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 W 63RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60629-5010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-581-5600
Provider Business Mailing Address Fax Number:
773-581-5608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 TODD FARM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123-1287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-841-8500
Provider Business Practice Location Address Fax Number:
847-841-7268
Provider Enumeration Date:
08/01/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLGUIN
Authorized Official First Name:
NORMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
773-581-5600

Provider Taxonomy Codes

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

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