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General NPI Number Information
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NPI Number | 1730218652
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Entity Type | Organization
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Legal Business Name | RADIOLOGIC INTERPRETATIONS OF SOUTHERN ILLINOIS LTD
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 1200 CEDAR COURT
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City | CARBONDALE
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State | IL
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Zip | 62901-5334
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Country | US
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Telephone | 618-529-8500
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Fax | 618-549-1000
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Provider Business Mailing Address
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Address Line | 1200 CEDAR COURT
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City | CARBONDALE
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State | IL
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Zip | 62901-5334
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Country | US
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Telephone | 618-529-8500
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Fax | 618-549-1000
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS L FULK
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Credential | MD
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Telephone | 618-529-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State |
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