Provider Demographics
NPI:1528013422
Name:ILLINI MRI LLC
Entity Type:Organization
Organization Name:ILLINI MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRUHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-792-4265
Mailing Address - Street 1:801 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1804
Mailing Address - Country:US
Mailing Address - Phone:309-792-9363
Mailing Address - Fax:563-421-3419
Practice Address - Street 1:801 ILLINI DR
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1804
Practice Address - Country:US
Practice Address - Phone:309-792-9363
Practice Address - Fax:563-421-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
634002OtherHEALTHLINK
IL0813286OtherBLUE CROSS ILLINOIS
ILIL0100OtherJOHN DEERE HEALTHCARE
IA90359OtherIOWA BLUE CROSS
IA90359OtherIOWA BLUE CROSS