Provider Demographics
NPI:1437195393
Name:TOUCHSTONE IMAGING OF PEORIA, LLC
Entity Type:Organization
Organization Name:TOUCHSTONE IMAGING OF PEORIA, LLC
Other - Org Name:PEORIA IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:615-661-9200
Mailing Address - Street 1:PO BOX 102871
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2871
Mailing Address - Country:US
Mailing Address - Phone:309-692-7674
Mailing Address - Fax:309-692-1209
Practice Address - Street 1:6708 N KNOXVILLE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2862
Practice Address - Country:US
Practice Address - Phone:309-692-7674
Practice Address - Fax:309-692-1209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOUCHSTONE MEDICAL IMAGING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL209149Medicare PIN