Healthcare Provider Details

I. General information

NPI: 1114078409
Provider Name (Legal Business Name): COMMUNITY IMAGING,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 W LOOP RD
WHEATON IL
60187-1034
US

IV. Provider business mailing address

270 W LOOP RD
WHEATON IL
60189-2034
US

V. Phone/Fax

Practice location:
  • Phone: 630-653-8464
  • Fax: 630-653-8660
Mailing address:
  • Phone: 630-653-8464
  • Fax: 630-653-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY D WENDT
Title or Position: REGIONAL MANAGER
Credential:
Phone: 630-653-8464