Provider Demographics
NPI:1942382361
Name:HINSDALE ORTHOPAEDIC IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:HINSDALE ORTHOPAEDIC IMAGING CENTER, LLC
Other - Org Name:HINSDALE ORTHOPAEDIC ASSOCIATES, SC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-462-3474
Mailing Address - Street 1:550 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3186
Mailing Address - Country:US
Mailing Address - Phone:630-323-6116
Mailing Address - Fax:630-323-6169
Practice Address - Street 1:420 NELSON RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2946
Practice Address - Country:US
Practice Address - Phone:815-462-3474
Practice Address - Fax:815-462-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
532180Medicare UPIN