Provider Demographics
NPI:1134178502
Name:SPRINGFIELD RADIOLOGISTS SC
Entity type:Organization
Organization Name:SPRINGFIELD RADIOLOGISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-544-2149
Mailing Address - Street 1:611 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5327
Mailing Address - Country:US
Mailing Address - Phone:217-544-2149
Mailing Address - Fax:217-544-9553
Practice Address - Street 1:611 N 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5327
Practice Address - Country:US
Practice Address - Phone:217-544-2149
Practice Address - Fax:217-544-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF1100OtherRR MEDICARE
IL103749OtherHEALTHLINK
IL08415052OtherBCBS
ILCI7752OtherRRMED
IL08415052OtherBCBS
IL276990Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER