MEDICARE: BJ DIAGNOSTIC SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1114057288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BJ DIAGNOSTIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 9293
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60598-9293
Country	:	US
Telephone Number	:	630-585-8372
Fax Number	:	630-585-8372

Provider Business Practice Location Address
First Line	:	1608 W 69TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-3316
Country	:	US
Telephone Number	:	773-471-0017
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MOHAMMAD A JAMAL
Credential	:
Telephone Number	:	630-585-8372

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	03/03/2009

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Directions to “BJ DIAGNOSTIC SERVICES, INC. ” Practice Location

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