Provider Demographics
NPI:1093976839
Name:HOME IMAGES OF ILLINOIS
Entity Type:Organization
Organization Name:HOME IMAGES OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:C
Authorized Official - Last Name:HEARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-788-4527
Mailing Address - Street 1:PO BOX 1013
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4013
Mailing Address - Country:US
Mailing Address - Phone:630-788-4527
Mailing Address - Fax:
Practice Address - Street 1:2241 207TH PL
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60411-1538
Practice Address - Country:US
Practice Address - Phone:630-788-4527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPENDING247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicare PIN