Provider Demographics
NPI:1376959312
Name:NATIONAL IMAGING LLC
Entity Type:Organization
Organization Name:NATIONAL IMAGING LLC
Other - Org Name:MOLECULAR IMAGING OF ORLAND PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOQUEET
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-325-6300
Mailing Address - Street 1:14315 108TH AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5700
Mailing Address - Country:US
Mailing Address - Phone:708-428-1910
Mailing Address - Fax:708-428-1909
Practice Address - Street 1:14315 108TH AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5700
Practice Address - Country:US
Practice Address - Phone:708-428-1910
Practice Address - Fax:708-428-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7833Medicare UPIN