MEDICARE: TRIUMPH RADIOLOGY, 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1487692844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIUMPH RADIOLOGY, INC.

Provider Business Mailing Address
First Line	:	1640 WILLOW CIRCLE DR
Second Line	:	SUITE 400
City	:	CREST HILL
State	:	IL
Zip	:	60403-0959
Country	:	US
Telephone Number	:	815-741-4148
Fax Number	:	815-741-4686

Provider Business Practice Location Address
First Line	:	1640 WILLOW CIRCLE DR
Second Line	:	SUITE 400
City	:	CREST HILL
State	:	IL
Zip	:	60403-0959
Country	:	US
Telephone Number	:	815-741-4148
Fax Number	:	815-741-4686

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL CHELLAPPA
Credential	:
Telephone Number	:	815-741-4148

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/11/2012

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