MEDICARE: SALINE VALLEY DIAGNOSTIC RADIOLOGY, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518019470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALINE VALLEY DIAGNOSTIC RADIOLOGY, SC

Provider Business Mailing Address
First Line	:	75 REMITTANCE DR DEPT 3144
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60675-3144
Country	:	US
Telephone Number	:	618-252-8337
Fax Number	:	618-252-8338

Provider Business Practice Location Address
First Line	:	112 E CLARK ST
Second Line	:
City	:	HARRISBURG
State	:	IL
Zip	:	62946-2703
Country	:	US
Telephone Number	:	618-252-8337
Fax Number	:	618-252-8338

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	SHARLEE LEBLEU
Credential	:
Telephone Number	:	480-321-7026

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/12/2024

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