=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154553253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MBS IMAGING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2009
-----------------------------------------------------
Last Update Date | 05/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 S. HIGHLAND AVENUE BUILDING 'C' SUITE 100
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-6134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-495-7152
-----------------------------------------------------
Fax | 877-495-7208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1919 S. HIGHLAND AVENUE, BUILDING 'C' SUITE 100
-----------------------------------------------------
City | LOMBARD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60148-6134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-495-7152
-----------------------------------------------------
Fax | 877-495-7208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. MIRWAJID A SHAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-613-9590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------