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General NPI Number Information
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NPI Number | 1811401284
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Entity Type | Organization
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Legal Business Name | SUMMIT RADIOLOGY, LLC
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 3849 N. PERRYVILLE ROAD
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City | ROCKFORD
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State | IL
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Zip | 61114
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Country | US
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Telephone | 815-654-2486
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Fax | 815-654-2680
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Provider Business Mailing Address
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Address Line | 3849 N. PERRYVILLE ROAD
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City | ROCKFORD
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State | IL
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Zip | 61114
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Country | US
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Telephone | 815-654-2486
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Fax | 815-654-2680
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTIN A. URBAN
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Credential | MD
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Telephone | 815-654-2486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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