Provider Demographics
NPI:1912220468
Name:MIDWEST CENTER FOR ADVANCED IMAGING, LLC
Entity Type:Organization
Organization Name:MIDWEST CENTER FOR ADVANCED IMAGING, LLC
Other - Org Name:MCAI YORKVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-236-8300
Mailing Address - Street 1:4355 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9542
Mailing Address - Country:US
Mailing Address - Phone:630-236-8300
Mailing Address - Fax:630-236-9860
Practice Address - Street 1:4355 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9542
Practice Address - Country:US
Practice Address - Phone:630-236-8300
Practice Address - Fax:630-236-9860
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST CENTER FOR ADVANCED IMAGING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-11
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL72461Medicare UPIN
IL553480Medicare PIN