Healthcare Provider Details

I. General information

NPI: 1013967710
Provider Name (Legal Business Name): ALPHA MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N ROSELLE RD
ROSELLE IL
60172-1581
US

IV. Provider business mailing address

11 N ROSELLE RD
ROSELLE IL
60172-1581
US

V. Phone/Fax

Practice location:
  • Phone: 630-894-0700
  • Fax: 630-894-0701
Mailing address:
  • Phone: 630-894-0700
  • Fax: 630-894-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. KRESS STEIN
Title or Position: OWNER
Credential:
Phone: 630-894-0700