Provider Demographics
NPI:1902359813
Name:ILLINOIS VALLEY RADIOLOGY, SC
Entity Type:Organization
Organization Name:ILLINOIS VALLEY RADIOLOGY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HILBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-288-8701
Mailing Address - Street 1:401 E MURPHY AVE
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-2724
Mailing Address - Country:US
Mailing Address - Phone:724-288-8701
Mailing Address - Fax:815-371-0750
Practice Address - Street 1:401 E MURPHY AVE
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-2724
Practice Address - Country:US
Practice Address - Phone:724-288-8701
Practice Address - Fax:815-371-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060032L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty