1568496511 NPI number — ENHANCED MEDICAL IMAGING OF ELGIN LLC

Table of content: (NPI 1568496511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568496511 NPI number — ENHANCED MEDICAL IMAGING OF ELGIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENHANCED MEDICAL IMAGING OF ELGIN 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:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1568496511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 58TH ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
KENOSHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53140-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-925-0990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 FLETCHER 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:
60123-4703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-841-1007
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WNUCK
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
262-925-0990

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)





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