Provider Demographics
NPI:1407162720
Name:TINLEY PARK OPEN MRI & IMAGING CENTER LTD
Entity Type:Organization
Organization Name:TINLEY PARK OPEN MRI & IMAGING CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:YASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-381-5422
Mailing Address - Street 1:22017 EMILY LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-7817
Mailing Address - Country:US
Mailing Address - Phone:815-534-5420
Mailing Address - Fax:815-880-8234
Practice Address - Street 1:18660 GRAPHIC DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6257
Practice Address - Country:US
Practice Address - Phone:708-381-5422
Practice Address - Fax:708-381-5429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5612Medicare UPIN