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General NPI Number Information
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NPI Number | 1134178502
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD RADIOLOGISTS SC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 611 N 6TH ST
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City | SPRINGFIELD
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State | IL
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Zip | 62702-5327
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Country | US
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Telephone | 217-544-2149
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Fax | 217-544-9553
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Provider Business Mailing Address
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Address Line | 611 N 6TH ST
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City | SPRINGFIELD
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State | IL
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Zip | 62702-5327
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Country | US
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Telephone | 217-544-2149
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Fax | 217-544-9553
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. STEPHEN LEE
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Credential |
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Telephone | 217-544-2149
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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 |
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