Provider Demographics
NPI:1467731620
Name:MONTY P KAROLL, MD PC
Entity Type:Organization
Organization Name:MONTY P KAROLL, MD PC
Other - Org Name:DRX IMAGING/MOBILE HEALTH SCREENING AND DIAGNOSTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:P
Authorized Official - Last Name:KAROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-222-8874
Mailing Address - Street 1:200 N 8TH ST STE 99
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3062
Mailing Address - Country:US
Mailing Address - Phone:217-222-8874
Mailing Address - Fax:217-222-8874
Practice Address - Street 1:639 YORK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3963
Practice Address - Country:US
Practice Address - Phone:217-224-5031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060007282261QR0200X, 261QR0208X
IL036064059261QR0200X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile