AMERICAN DIAGNOSTIC MRI LLC - NPI NUMBER 1396002309

Summary

Provider Name: AMERICAN DIAGNOSTIC MRI LLC

NPI Number: 1396002309

Clasification: Clinic/Center (261QM1200X)

Specialization: Magnetic Resonance Imaging (MRI)

Address:
360 W BUTTERFIELD RD
SUITE 130
ELMHURST, IL
ZIP 60126

Phone Number: (630) 333-4674



Detailed Information

AMERICAN DIAGNOSTIC MRI LLC is a magnetic resonance imaging (mri) clinic/center in Elmhurst, IL. The assigned NPI number for this provider is 1396002309 and is registered as an organization entity type.

The provider's business address is:

360 W BUTTERFIELD RD
SUITE 130
ELMHURST, IL
ZIP 60126-068
Phone: (630) 333-4674
Fax: (630) 333-4567

The provider's authorized official is Marvin Tazelaar .
The authorized official title is Director and has the following contact phone number (630) 333-4674.

The enumeration date for this NPI number is 4/13/2012 and was last updated on 4/13/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QM1200X Clinic/Center Magnetic Resonance Imaging (MRI) Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 4853951 OTHER IL LISC

NPI Record

No. Field Name Field Value
1 NPI 1396002309
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name AMERICAN DIAGNOSTIC MRI LLC
5 Provider First Line Business Practice Location Address 360 W BUTTERFIELD RD
6 Provider Second Line Business Practice Location Address SUITE 130
7 Provider Business Practice Location Address City Name ELMHURST
8 Provider Business Practice Location Address State Name IL
9 Provider Business Practice Location Address Postal Code 601265068
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 6303334674
12 Provider Business Practice Location Address Fax Number 6303334567
13 Provider Enumeration Date 4/13/2012
14 Last Update Date 4/13/2012
15 Authorized Official Last Name TAZELAAR
16 Authorized Official First Name MARVIN
17 Authorized Official Title or Position DIRECTOR
18 Authorized Official Telephone Number 6303334674
19 Healthcare Provider Taxonomy Code 1 261QM1200X
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Other Provider Identifier 1 4853951
22 Other Provider Identifier Type Code 1 01
23 Other Provider Identifier State 1 IL
24 Other Provider Identifier Issuer 1 LISC
25 Is Organization Subpart N

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.