Provider Demographics
NPI:1194825372
Name:PARKSIDE MAGNETIC RESONANCE CENTER, LTD
Entity Type:Organization
Organization Name:PARKSIDE MAGNETIC RESONANCE CENTER, LTD
Other - Org Name:PARKSIDE MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-696-7900
Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:SUITE G06
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-696-7900
Mailing Address - Fax:847-692-4593
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:SUITE G06
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-696-7900
Practice Address - Fax:847-692-4593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214992OtherMEDICARE ID - IDTF
IL214992OtherMEDICARE ID - IDTF