Provider Demographics
NPI:1982709135
Name:ASSOCIATED ST JAMES RADIOLOGISTS SC
Entity Type:Organization
Organization Name:ASSOCIATED ST JAMES RADIOLOGISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:S
Authorized Official - Last Name:COCCARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-756-1000
Mailing Address - Street 1:1423 CHICAGO RD
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3400
Mailing Address - Country:US
Mailing Address - Phone:708-756-1000
Mailing Address - Fax:
Practice Address - Street 1:1423 CHICAGO RD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3400
Practice Address - Country:US
Practice Address - Phone:708-756-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1618334OtherBCBS ID
ILCA8284OtherRAILROAD
ILN244858OtherHARMONY
IL1618334OtherBCBS ID
ILN244858OtherHARMONY