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General NPI Number Information
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NPI Number | 1346075447
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Entity Type | Organization
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Legal Business Name | SAH RADIOLOGY LLC
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 2875 W 19TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-3501
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Country | US
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Telephone | 773-484-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1169
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Country | US
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Telephone | 773-484-1000
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL DTR RCM PFS
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Name | ROSE ROSARIO
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Credential |
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Telephone | 773-484-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2471V0106X
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Taxonomy Name | Vascular-Interventional Technology Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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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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