Provider Demographics
NPI:1518283597
Name:EDWARD HOSPITAL IMAGING CENTER PLAINFIELD
Entity Type:Organization
Organization Name:EDWARD HOSPITAL IMAGING CENTER PLAINFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-527-3010
Mailing Address - Street 1:801 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7430
Mailing Address - Country:US
Mailing Address - Phone:630-527-3000
Mailing Address - Fax:
Practice Address - Street 1:24600 W 127TH ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9507
Practice Address - Country:US
Practice Address - Phone:815-731-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology