Provider Demographics
NPI:1508002809
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:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-988-1093
Mailing Address - Street 1:126 S ASSEMBLY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-4545
Mailing Address - Country:US
Mailing Address - Phone:803-988-1093
Mailing Address - Fax:803-988-8185
Practice Address - Street 1:10419 FLEMING RD
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-3391
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:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile