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General NPI Number Information
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NPI Number | 1275676983
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Entity Type | Organization
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Legal Business Name | SHARED IMAGING
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 2801 MEDICAL CENTER DR
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City | POCAHONTAS
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State | AR
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Zip | 72455-9436
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Country | US
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Telephone | 630-483-3980
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Fax | 630-483-3986
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Provider Business Mailing Address
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Address Line | 801 PHOENIX LAKE AVE
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City | STREAMWOOD
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State | IL
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Zip | 60107-2363
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Country | US
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Telephone | 630-483-3980
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Fax | 630-483-3986
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RAYMOND STACHOWIAK
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Credential |
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Telephone | 630-483-3980
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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 |
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