Healthcare Provider Details

I. General information

NPI: 1184799363
Provider Name (Legal Business Name): JR IMAGING MOBILE ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 HAWTHORNE TER
DES PLAINES IL
60016-3529
US

IV. Provider business mailing address

1778 HAWTHORNE TER
DES PLAINES IL
60016-3529
US

V. Phone/Fax

Practice location:
  • Phone: 773-710-4025
  • Fax: 773-637-2006
Mailing address:
  • Phone: 773-710-4025
  • Fax: 773-637-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. JOSE BEJARANO
Title or Position: PRESIDENT
Credential:
Phone: 773-710-4025