NORTHWEST MEDICAL IMAGING , NPI 1770675498 — CHICAGO (IL)

NPI 1770675498

13+ Years Experience Organization

NORTHWEST MEDICAL IMAGING

09/29/2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1770675498
NPI NUMBER

About NORTHWEST MEDICAL IMAGING

NORTHWEST MEDICAL IMAGING is a provider established in CHICAGO, IL. The NPI number of NORTHWEST MEDICAL IMAGING is 1770675498 and was assigned on 09/29/2006. The practitioners primary taxonomy code is: 247100000X IL .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 607072718
  • Phone: 7736371700
  • Address: 2333 N HARLEM AVE

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1770675498
  • Phone : 7736371700
  • Postalcode : 607072718
  • Address : 2333 N HARLEM AVE

Provider taxonomy - Radiologic Technologist

  • Taxonomy code: 247100000X
  • License state: IL

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy group: 193200000X MULTI-SPECIALTY GROUP.

Taxonomy description: An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment.

Contacts:

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  • NORTHWEST MEDICAL IMAGING
  • Address : 2333 N HARLEM AVE
  • Region : CHICAGO, IL
  • NPI : 1770675498
  • Phone : 7736371700
  • Postalcode : 607072718

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 7736371700
  • Title or position : PRESIDENT
  • Credentials : MD DPM

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address2333 N HARLEM AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code607072718
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number7736371700
The telephone number associated with the location address of the provider being identified.
NPI1770675498
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1247100000X
An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment.
Provider Enumeration Date09/29/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)NORTHWEST MEDICAL IMAGING
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address2333 N HARLEM AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code607072718
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number7736371700
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Authorized Official Last NameHRYWNAK
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameSEVERKO
The first name of the authorized official
Authorized Official Title or PositionPRESIDENT
The title or position of the authorized official
Authorized Official Name Prefix TextDR.
Authorized Official Name Prefix Text
Authorized Official Credential TextMD DPM
Authorized Official Credential Text
Authorized Official Telephone Number7736371700
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1247100000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiologic Technologist
An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment.
Provider License Number State Code 1IL
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
X

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