Provider Demographics
NPI:1831261205
Name:PMI DIAGNOSTIC IMAGING LLC
Entity type:Organization
Organization Name:PMI DIAGNOSTIC IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:IMAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MIONI
Authorized Official - Suffix:
Authorized Official - Credentials:RTRMR BS
Authorized Official - Phone:708-361-9852
Mailing Address - Street 1:7600 W COLLEGE DR
Mailing Address - Street 2:PMI DIAGNOSTIC IMAGING
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-923-2577
Mailing Address - Fax:708-361-8425
Practice Address - Street 1:7600 W COLLEGE DR
Practice Address - Street 2:PMI DIAGNOSTIC IMAGING
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-923-2577
Practice Address - Fax:708-361-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01621320OtherBCBS
01621320OtherBCBS