Healthcare Provider Details

I. General information

NPI: 1982709135
Provider Name (Legal Business Name): ASSOCIATED ST JAMES RADIOLOGISTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 CHICAGO RD RADIOLOGY DEPARTMENT
CHICAGO HEIGHTS IL
60411-3400
US

IV. Provider business mailing address

1423 CHICAGO RD RADIOLOGY DEPARTMENT
CHICAGO HEIGHTS IL
60411-3400
US

V. Phone/Fax

Practice location:
  • Phone: 708-756-1000
  • Fax:
Mailing address:
  • Phone: 708-756-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGG S COCCARO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-756-1000