Provider Demographics
NPI:1578605994
Name:IMAGING CENTER OF ALTON, LLC
Entity Type:Organization
Organization Name:IMAGING CENTER OF ALTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-655-2400
Mailing Address - Street 1:132 N KANSAS ST STE 212
Mailing Address - Street 2:P.O. BOX 868
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1782
Mailing Address - Country:US
Mailing Address - Phone:618-655-2400
Mailing Address - Fax:618-659-1197
Practice Address - Street 1:3 PROFESSIONAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5067
Practice Address - Country:US
Practice Address - Phone:618-465-4674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology