Healthcare Provider Details

I. General information

NPI: 1477841146
Provider Name (Legal Business Name): UNITED DIAGNOSTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S CHICAGO ST
LINCOLN IL
62656-2719
US

IV. Provider business mailing address

5533 W 109TH ST STE 101
OAK LAWN IL
60453-5058
US

V. Phone/Fax

Practice location:
  • Phone: 217-732-1122
  • Fax: 217-732-1144
Mailing address:
  • Phone: 708-424-9405
  • Fax: 708-424-8038

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 Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: SAMI BAIG
Title or Position: PRESIDENT
Credential:
Phone: 708-424-9405