Provider Demographics
NPI:1003969841
Name:MEDCO DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:MEDCO DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GERACI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-245-9970
Mailing Address - Street 1:900 E DIEHL ROAD
Mailing Address - Street 2:SUITE 141
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2391
Mailing Address - Country:US
Mailing Address - Phone:630-245-9970
Mailing Address - Fax:630-245-9974
Practice Address - Street 1:900 E DIEHL ROAD
Practice Address - Street 2:SUITE 141
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2391
Practice Address - Country:US
Practice Address - Phone:630-245-9970
Practice Address - Fax:630-245-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
2219737OtherBCBS
IL300119392OtherMEDICARE RAILROAD
IL300119392OtherMEDICARE RAILROAD