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General NPI Number Information
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NPI Number | 1326421363
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Entity Type | Organization
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Legal Business Name | MEDI-RAY PORTABLE, INC
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 7132 N HARLEM AVE STE 104
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City | CHICAGO
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State | IL
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Zip | 60631-1086
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Country | US
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Telephone | 773-594-0780
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Fax | 773-945-6742
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Provider Business Mailing Address
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Address Line | 7132 N HARLEM AVE STE 104
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City | CHICAGO
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State | IL
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Zip | 60631-1086
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Country | US
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Telephone | 773-594-0780
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Fax | 773-945-6742
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHIV R KUMAR
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Credential |
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Telephone | 773-594-0780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 209859
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License Number State | IL
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