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General NPI Number Information
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NPI Number | 1407825342
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Entity Type | Organization
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Legal Business Name | ELITE IMAGING OF FAIRVIEW HEIGHTS, LLC
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 12 WOLF CREEK DR STE 300
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City | SWANSEA
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State | IL
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Zip | 62226-2314
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Country | US
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Telephone | 618-632-2900
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Fax | 618-632-2901
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Provider Business Mailing Address
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Address Line | 12 WOLF CREEK DR STE 300
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City | SWANSEA
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State | IL
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Zip | 62226-2314
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Country | US
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Telephone | 618-632-2900
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Fax | 618-632-2901
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. MATTHEW A RUYLE
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Credential | M.D.
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Telephone | 618-632-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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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 | 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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