=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295952059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARRINGTON RADIOLOGY, S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2007
-----------------------------------------------------
Last Update Date | 04/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ST. BERNARD HOSPITAL, 326 W. 64TH STREET 2ND FLOOR (RADIOLOGY DEPARTMENT)
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-962-3900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 CARRINGTON COURT
-----------------------------------------------------
City | HAZEL CREST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-839-0118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAMES BECKETT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 773-962-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 036-087374
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------