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General NPI Number Information
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NPI Number | 1417950437
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Entity Type | Organization
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Legal Business Name | ILLINI OPEN MRI, LLC
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 2147 S NEIL ST
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City | CHAMPAIGN
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State | IL
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Zip | 61820-7593
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Country | US
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Telephone | 217-359-8339
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Fax | 217-359-9833
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Provider Business Mailing Address
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Address Line | 2147 S NEIL ST
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City | CHAMPAIGN
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State | IL
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Zip | 61820-7593
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Country | US
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Telephone | 217-359-8339
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Fax | 217-359-9833
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. MICHELLE DOUGLAS
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Credential |
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Telephone | 502-403-1401
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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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