Basic Information
| Provider Information | |||||||||
| NPI: | 1114078409 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY IMAGING,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 W LOOP RD | ||||||||
| Address2: | |||||||||
| City: | WHEATON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601892034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306538464 | ||||||||
| FaxNumber: | 6306538660 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 W LOOP RD | ||||||||
| Address2: | |||||||||
| City: | WHEATON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601871034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306538464 | ||||||||
| FaxNumber: | 6306538660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 01/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | WENDT | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6306538464 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.