Provider Demographics
NPI:1043245285
Name:ELK GROVE MRI INC.
Entity Type:Organization
Organization Name:ELK GROVE MRI INC.
Other - Org Name:MRI PROFESSIONALS OF ELK GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:YUQUILIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-357-9300
Mailing Address - Street 1:901 BIESTERFIELD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3393
Mailing Address - Country:US
Mailing Address - Phone:847-357-9300
Mailing Address - Fax:847-357-0800
Practice Address - Street 1:901 BIESTERFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3393
Practice Address - Country:US
Practice Address - Phone:847-357-9300
Practice Address - Fax:847-357-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31623087OtherBLUE CROSS BLUE SHIELD
IL216796Medicare PIN