Provider Demographics
NPI:1851523534
Name:PROVIDERS MEDICAL IMAGING AND MANAGEMENT
Entity Type:Organization
Organization Name:PROVIDERS MEDICAL IMAGING AND MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-377-3730
Mailing Address - Street 1:11600 S KEDZIE AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:MERRIONETTE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60803-6307
Mailing Address - Country:US
Mailing Address - Phone:708-377-3730
Mailing Address - Fax:708-293-0255
Practice Address - Street 1:11600 S KEDZIE AVE
Practice Address - Street 2:SUITE H
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-6307
Practice Address - Country:US
Practice Address - Phone:708-377-3730
Practice Address - Fax:708-293-0255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMIC MERRIONETTE PARK, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology