1205166915 NPI number — MEDPRO IMAGING MOBILE SERVICES, LLC

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 1205166915 NPI number — MEDPRO IMAGING MOBILE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDPRO IMAGING MOBILE SERVICES, LLC
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:
1205166915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 N RANDALL RD STE 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60123-9406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-987-8744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 MCDONALD RD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60177-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-797-0895
Provider Business Practice Location Address Fax Number:
888-987-8744
Provider Enumeration Date:
12/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFMAN
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
PRESIDEND/CEO
Authorized Official Telephone Number:
630-425-0088

Provider Taxonomy Codes

  • Taxonomy code: 2471S1302X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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