Healthcare Provider Details

I. General information

NPI: 1538225842
Provider Name (Legal Business Name): MIDWEST X-RAY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W ROOSEVELT RD UNIT 77 BLDG 11
WEST CHICAGO IL
60185-3739
US

IV. Provider business mailing address

1031 MOUNT AUBURN RD
EVANSVILLE IN
47720-8226
US

V. Phone/Fax

Practice location:
  • Phone: 630-293-8718
  • Fax: 630-293-8724
Mailing address:
  • Phone: 812-425-4682
  • Fax: 812-425-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number9252963
License Number StateIL

VIII. Authorized Official

Name: MS. SANDY ASHBY
Title or Position: RADIOLOGY MANAGER
Credential: RT
Phone: 812-425-4682