Provider Demographics
NPI:1922380211
Name:VANTAGE IMAGING SERVICES, INC.
Entity Type:Organization
Organization Name:VANTAGE IMAGING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WUERFL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-270-2494
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0735
Mailing Address - Country:US
Mailing Address - Phone:630-270-2494
Mailing Address - Fax:630-405-0999
Practice Address - Street 1:22606 DEER PATH LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2180
Practice Address - Country:US
Practice Address - Phone:630-270-2494
Practice Address - Fax:630-405-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)