Healthcare Provider Details

I. General information

NPI: 1346228848
Provider Name (Legal Business Name): TRI COUNTY RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 N KNOXVILLE AVE
PEORIA IL
61615
US

IV. Provider business mailing address

PO BOX 3853
PEORIA IL
61612-3853
US

V. Phone/Fax

Practice location:
  • Phone: 309-682-7750
  • Fax: 309-682-7786
Mailing address:
  • Phone: 800-899-5757
  • Fax: 314-821-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. W ROBERT COOPER
Title or Position: CMPE, CHBC
Credential:
Phone: 309-682-7750