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General NPI Number Information
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NPI Number | 1639451297
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Entity Type | Organization
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Legal Business Name | MATTESON MRI INC
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 4801 SOUTHWICK DR SUITE 101
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City | MATTESON
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State | IL
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Zip | 60443-2254
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Country | US
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Telephone | 708-481-9300
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Fax | 708-481-9320
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Provider Business Mailing Address
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Address Line | 4801 SOUTHWICK DR SUITE 101
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City | MATTESON
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State | IL
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Zip | 60443-2254
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Country | US
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Telephone | 708-481-9300
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Fax | 708-481-9320
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Authorized Official
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Title or Position | MANAGER
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Name | TERRI NASSAR
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Credential |
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Telephone | 708-481-9300
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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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Taxonomy #2
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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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