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General NPI Number Information
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NPI Number | 1467590471
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Entity Type | Organization
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Legal Business Name | SUBURBAN XRAY
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7 N 130 MEDINAH RD UNIT A
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City | MEDINAH
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State | IL
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Zip | 60157
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Country | US
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Telephone | 630-529-0077
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Fax | 630-529-0087
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Provider Business Mailing Address
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Address Line | PO BOX 471
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City | MEDINAH
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State | IL
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Zip | 60157
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Country | US
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Telephone | 630-529-0077
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Fax | 630-529-0087
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAMELA A BALLARD
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Credential | DC
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Telephone | 630-529-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 58494275
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License Number State | IL
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