Healthcare Provider Details

I. General information

NPI: 1538390737
Provider Name (Legal Business Name): SHARED IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST CT SCANNER
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

801 PHOENIX LAKE AVE
STREAMWOOD IL
60107-2363
US

V. Phone/Fax

Practice location:
  • Phone: 800-606-0266
  • Fax:
Mailing address:
  • Phone: 800-606-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID NEALLY
Title or Position: VICE PRESIDENT
Credential:
Phone: 800-606-0266