Provider Demographics
NPI:1497049613
Name:ICI 24 7 PC
Entity Type:Organization
Organization Name:ICI 24 7 PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIX
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-480-9692
Mailing Address - Street 1:75 REMITTANCE DR DEPT 6597
Mailing Address - Street 2:DEPT 6597
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6597
Mailing Address - Country:US
Mailing Address - Phone:951-786-0801
Mailing Address - Fax:855-226-5960
Practice Address - Street 1:727 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1274
Practice Address - Country:US
Practice Address - Phone:434-348-4400
Practice Address - Fax:434-348-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty