Provider Demographics
NPI:1467417931
Name:INMED DIAGNOSTIC SERVICES OF IL, LLC
Entity Type:Organization
Organization Name:INMED DIAGNOSTIC SERVICES OF IL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-510-3704
Mailing Address - Street 1:2400 E. COMMERCIAL
Mailing Address - Street 2:SUITE 826
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-510-3700
Mailing Address - Fax:954-510-2649
Practice Address - Street 1:4119 S WATER TOWER PLACE
Practice Address - Street 2:SUITE A
Practice Address - City:MT. VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-9595
Practice Address - Country:US
Practice Address - Phone:618-985-8007
Practice Address - Fax:618-985-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
216061Medicare PIN
IL216061Medicare PIN