Healthcare Provider Details

I. General information

NPI: 1275676983
Provider Name (Legal Business Name): SHARED IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 MEDICAL CENTER DR
POCAHONTAS AR
72455-9436
US

IV. Provider business mailing address

801 PHOENIX LAKE AVE
STREAMWOOD IL
60107-2363
US

V. Phone/Fax

Practice location:
  • Phone: 630-483-3980
  • Fax: 630-483-3986
Mailing address:
  • Phone: 630-483-3980
  • Fax: 630-483-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND STACHOWIAK
Title or Position: PRESIDENT
Credential:
Phone: 630-483-3980