MEDICARE: TOUHY DIAGNOSTIC AT HOME, LLC

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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1164850996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOUHY DIAGNOSTIC AT HOME, LLC

Provider Business Mailing Address
First Line	:	1293 RAND RD
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-3402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 HARDER CT
Second Line	:	SUITE# E
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-1696
Country	:	US
Telephone Number	:	847-803-1111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SALIM UDDIN
Credential	:
Telephone Number	:	847-803-1111

Provider Enumeration Date	:	10/14/2013
Last Update Date	:	12/02/2013

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