Provider Demographics
NPI:1679695332
Name:MEDISCAN IMAGING CENTER OF ROCKFORD LLC
Entity Type:Organization
Organization Name:MEDISCAN IMAGING CENTER OF ROCKFORD LLC
Other - Org Name:HIGH FIELD OPEN MRI OF ROCKFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AVNEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-636-2244
Mailing Address - Street 1:2415 CERRO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1004
Mailing Address - Country:US
Mailing Address - Phone:815-636-2244
Mailing Address - Fax:815-633-0432
Practice Address - Street 1:6957 OLDE CREEK RD STE 4100
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-7416
Practice Address - Country:US
Practice Address - Phone:815-636-2244
Practice Address - Fax:815-633-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty