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General NPI Number Information
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NPI Number | 1265758247
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Entity Type | Organization
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Legal Business Name | EDWARD HOSPITAL IMAGING CENTER BOOK RD
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/16/2010
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Provider Practice Location Address
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Address Line | 2007 95TH ST
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City | NAPERVILLE
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State | IL
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Zip | 60564-8459
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Country | US
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Telephone | 630-527-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 801 S WASHINGTON ST
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City | NAPERVILLE
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State | IL
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Zip | 60540-7430
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Country | US
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Telephone | 630-527-3000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MS. PAM DAVIS
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Credential |
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Telephone | 630-527-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | IL
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