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NPI Code Detail

MEDICARE: CLINTON IMAGING SERVICES, LLC

MEDICARE: CLINTON IMAGING SERVICES, 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
1261QR0200XRadiology Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831187665
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLINTON IMAGING SERVICES, LLC
Provider Business Mailing Address
First Line : 615 VALLEY VIEW DR
Second Line : SUITE 202
City : MOLINE
State : IL
Zip : 61265-6180
Country : US
Telephone Number : 309-762-1072
Fax Number : 309-762-1094
Provider Business Practice Location Address
First Line : 1410 N 4TH ST
Second Line : SUITE A102
City : CLINTON
State : IA
Zip : 52732-2940
Country : US
Telephone Number : 563-244-3674
Fax Number : 563-244-3789
Authorized Official
Title or Position : PRESIDENT
Name : DR. CRAIG P. TILLMAN
Credential : M.D.
Telephone Number : 309-762-1072
Provider Enumeration Date : 10/06/2005
Last Update Date : 05/01/2013

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Directions to “CLINTON IMAGING SERVICES, LLC ” Practice Location

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