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General NPI Number Information
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NPI Number | 1528013422
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Entity Type | Organization
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Legal Business Name | ILLINI MRI LLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 801 ILLINI DR
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City | SILVIS
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State | IL
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Zip | 61282-1804
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Country | US
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Telephone | 309-792-9363
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Fax | 563-421-3419
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Provider Business Mailing Address
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Address Line | 801 ILLINI DR
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City | SILVIS
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State | IL
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Zip | 61282-1804
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Country | US
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Telephone | 309-792-9363
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Fax | 563-421-3419
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES E BRUHN
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Credential |
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Telephone | 309-792-4265
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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 | IL
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