Provider Demographics
NPI:1679853493
Name:APOLLO XRAY SERVICE, INC
Entity Type:Organization
Organization Name:APOLLO XRAY SERVICE, INC
Other - Org Name:APOLLO MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:847-657-1200
Mailing Address - Street 1:1460 MARKET ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4643
Mailing Address - Country:US
Mailing Address - Phone:847-657-1200
Mailing Address - Fax:847-657-1187
Practice Address - Street 1:1460 MARKET ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4643
Practice Address - Country:US
Practice Address - Phone:847-657-1200
Practice Address - Fax:847-657-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL9230657261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology