Provider Demographics
NPI:1255356820
Name:UNITED RADIOLOGY SERVICE
Entity type:Organization
Organization Name:UNITED RADIOLOGY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAGANNADHARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAHMAMDAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-431-8413
Mailing Address - Street 1:812 NORTH LOGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-431-8413
Mailing Address - Fax:217-431-1397
Practice Address - Street 1:812 NORTH LOGAN AVENUE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-431-8413
Practice Address - Fax:217-431-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN902080Medicare ID - Type Unspecified