Provider Demographics
NPI:1841244753
Name:CAMELOT RADIOLOGY ASSOCIATES LTD
Entity Type:Organization
Organization Name:CAMELOT RADIOLOGY ASSOCIATES LTD
Other - Org Name:NORTHERN ILLINOIS RADIOLOGISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-519-2600
Mailing Address - Street 1:3871 N PERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8080
Mailing Address - Country:US
Mailing Address - Phone:815-397-5554
Mailing Address - Fax:866-914-7594
Practice Address - Street 1:1045 W STEPHENSON ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4864
Practice Address - Country:US
Practice Address - Phone:815-397-5554
Practice Address - Fax:866-914-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL420004542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty