Provider Demographics
NPI:1851564389
Name:BERWYN MAGNETIC RESONANCE CENTER LLC
Entity Type:Organization
Organization Name:BERWYN MAGNETIC RESONANCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP & CHIEF ACCOUNTING OFFCR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DRAZBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9492-826-0000
Mailing Address - Street 1:PO BOX 404166
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7166
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3345 OAK PARK AVE
Practice Address - Street 2:MOBILE UNIT
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3434
Practice Address - Country:US
Practice Address - Phone:708-788-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERWYN MAGNETIC RESONANCE CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory