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General NPI Number Information
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NPI Number | 1467418137
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Entity Type | Organization
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Legal Business Name | EXCELL PORTABLE X-RAY SERVICE INC
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 2362 LEHMAN DR
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City | WEST CHICAGO
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State | IL
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Zip | 60185-6169
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Country | US
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Telephone | 630-762-8863
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Fax | 630-762-8864
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Provider Business Mailing Address
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Address Line | 2362 LEHMAN DR
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City | WEST CHICAGO
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State | IL
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Zip | 60185-6169
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Country | US
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Telephone | 630-762-8863
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Fax | 630-762-8864
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. MILYNE C MASING
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Credential |
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Telephone | 630-762-8863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 9251659
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License Number State | IL
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