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General NPI Number Information
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NPI Number | 1013046366
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Entity Type | Organization
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Legal Business Name | SALEM FLORA RADIOLOGY, S.C.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 815 W MAIN ST
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City | SALEM
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State | IL
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Zip | 62881-1408
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Country | US
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Telephone | 618-548-2843
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Fax | 618-548-2896
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Provider Business Mailing Address
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Address Line | 815 W MAIN ST P.O. BOX 875
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City | SALEM
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State | IL
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Zip | 62881-1408
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Country | US
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Telephone | 618-548-2843
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Fax | 618-548-2896
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | DR. PREECHA TAWJAREON
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Credential | M.D.
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Telephone | 618-548-2843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | IL
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