Provider Demographics
NPI:1588836878
Name:MEDICAL IMAGING TEMPORARIES INC
Entity Type:Organization
Organization Name:MEDICAL IMAGING TEMPORARIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:IDA
Authorized Official - Suffix:SR
Authorized Official - Credentials:RTR
Authorized Official - Phone:630-691-8366
Mailing Address - Street 1:1 S 521 WESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5058
Mailing Address - Country:US
Mailing Address - Phone:630-691-8366
Mailing Address - Fax:
Practice Address - Street 1:1 S 521 WESTVIEW AVE.
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5058
Practice Address - Country:US
Practice Address - Phone:630-691-8366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier