Provider Demographics
NPI:1568419778
Name:MEDIQUEST DIAGNOSTIC CENTER S.C
Entity Type:Organization
Organization Name:MEDIQUEST DIAGNOSTIC CENTER S.C
Other - Org Name:MED-QUEST RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABIHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:630-894-6105
Mailing Address - Street 1:3420 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3418
Mailing Address - Country:US
Mailing Address - Phone:773-604-4305
Mailing Address - Fax:847-296-8860
Practice Address - Street 1:3420 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3418
Practice Address - Country:US
Practice Address - Phone:773-604-4305
Practice Address - Fax:847-296-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILN / A246XS1301X
IL92581422471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty