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General NPI Number Information
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NPI Number | 1073043469
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Entity Type | Organization
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Legal Business Name | ENVISION MOBILE IMAGING, LLC
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 06/18/2017
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Provider Practice Location Address
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Address Line | 800 AUSTIN ST
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City | EVANSTON
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State | IL
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Zip | 60202-3439
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Country | US
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Telephone | 312-515-0289
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Fax |
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Provider Business Mailing Address
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Address Line | 800 AUSTIN ST
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City | EVANSTON
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State | IL
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Zip | 60202-3439
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARCELLO P PAOLELLA
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Credential |
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Telephone | 312-515-0289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State | IL
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