MEDICARE: NELLA DIAGNOSTICS

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1841951878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NELLA DIAGNOSTICS

Provider Business Mailing Address
First Line	:	5318 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4108
Country	:	US
Telephone Number	:	773-774-6440
Fax Number	:	773-774-6405

Provider Business Practice Location Address
First Line	:	1925 E 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4710
Country	:	US
Telephone Number	:	773-774-6440
Fax Number	:	773-774-6405

Authorized Official
Title or Position	:	MANAGER/ BILLER
Name	:	TERRI NASSAR
Credential	:
Telephone Number	:	708-650-0575

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	01/03/2022

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