Provider Demographics
NPI:1700860640
Name:SPECIALIZED IMAGING SERVICES, INC
Entity Type:Organization
Organization Name:SPECIALIZED IMAGING SERVICES, INC
Other - Org Name:DIAGNOSTIC HEALTH SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-242-8500
Mailing Address - Street 1:5055 KELLER SPRINGS RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5997
Mailing Address - Country:US
Mailing Address - Phone:214-242-8500
Mailing Address - Fax:214-242-8600
Practice Address - Street 1:350 S NORTHWEST HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4216
Practice Address - Country:US
Practice Address - Phone:847-656-5370
Practice Address - Fax:847-656-5371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL470000847Medicare PIN
IL=========001Medicaid