Provider Demographics
NPI:1003809674
Name:MRI ASSOCIATES OF ILLINOIS SC
Entity Type:Organization
Organization Name:MRI ASSOCIATES OF ILLINOIS SC
Other - Org Name:MERRIONETTE PARK MRI & IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-707-1100
Mailing Address - Street 1:1455 BROAD ST
Mailing Address - Street 2:FL 4
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3003
Mailing Address - Country:US
Mailing Address - Phone:973-707-1100
Mailing Address - Fax:973-707-1127
Practice Address - Street 1:11600 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-6302
Practice Address - Country:US
Practice Address - Phone:888-440-6494
Practice Address - Fax:330-759-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty