Provider Demographics
NPI:1487657433
Name:PEKIN MRI, LLC
Entity Type:Organization
Organization Name:PEKIN MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:V.
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:COYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-653-3968
Mailing Address - Street 1:1894 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4058
Mailing Address - Country:US
Mailing Address - Phone:330-653-3968
Mailing Address - Fax:330-656-1660
Practice Address - Street 1:1300 PARK AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-5038
Practice Address - Country:US
Practice Address - Phone:309-347-2143
Practice Address - Fax:309-347-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL200561Medicare ID - Type Unspecified