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General NPI Number Information
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NPI Number | 1437276508
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Entity Type | Organization
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Legal Business Name | INMED DIAGNOSTIC SERVICES OF IL LLC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 10419 FLEMING RD
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City | CARTERVILLE
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State | IL
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Zip | 62918-3391
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Country | US
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Telephone | 618-985-8007
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Fax | 618-985-8031
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Provider Business Mailing Address
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Address Line | 2400 E COMMERCIAL BLVD SUITE 826
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4054
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Country | US
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Telephone | 954-510-3700
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Fax | 954-510-2649
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Authorized Official
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Title or Position | COO
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Name | ELIZABETH LONGTON
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Credential |
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Telephone | 954-510-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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