1700862331 NPI number — METRO MRI CENTER LIMITED PARTNERSHIP

Table of content: (NPI 1700862331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700862331 NPI number — METRO MRI CENTER LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO MRI CENTER LIMITED PARTNERSHIP
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:
1700862331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 VALLEY VIEW DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-6180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-762-1072
Provider Business Mailing Address Fax Number:
309-762-1094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4480 UTICA RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
BETTENDORF
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52722-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-359-0277
Provider Business Practice Location Address Fax Number:
563-359-0645
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TILLMAN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
309-762-1072

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com