Provider Demographics
NPI:1164614772
Name:NAPERVILLE MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:NAPERVILLE MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-213-2700
Mailing Address - Street 1:9000 WAUKEGAN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2127
Mailing Address - Country:US
Mailing Address - Phone:847-213-2700
Mailing Address - Fax:847-213-2709
Practice Address - Street 1:1888 BAY SCOTT CIR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1106
Practice Address - Country:US
Practice Address - Phone:630-717-3700
Practice Address - Fax:630-717-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216406Medicare PIN