MEDICARE: PRI DIAGNOSTICS, 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	261QR0200X	Radiology Clinic/Center	01195492	IL

General Provider Information

NPI Number	:	1306873377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRI DIAGNOSTICS, LLC.

Provider Business Mailing Address
First Line	:	22285 PEPPER RD
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010
Country	:	US
Telephone Number	:	847-277-0936
Fax Number	:	847-277-0945

Provider Business Practice Location Address
First Line	:	1456 MOMENTUM PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5314
Country	:	US
Telephone Number	:	847-277-0936
Fax Number	:	847-277-0945

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	MR. WILLIAM ERBES
Credential	:
Telephone Number	:	847-277-0936

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/22/2020

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