Provider Demographics
NPI:1518002161
Name:HOSPITAL RADIOLOGY SERVICE, S.C.
Entity Type:Organization
Organization Name:HOSPITAL RADIOLOGY SERVICE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MERLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIACENTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-223-5288
Mailing Address - Street 1:# 8 US ROUTE 6 WEST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2943
Mailing Address - Country:US
Mailing Address - Phone:815-223-5288
Mailing Address - Fax:815-220-0252
Practice Address - Street 1:600 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1512
Practice Address - Country:US
Practice Address - Phone:815-664-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCC9316OtherRAILROAD MEDICARE
00615598OtherBLUE SHIELD ID
663210Medicare ID - Type Unspecified