PRESENCE AMBULATORY SERVICES NPI 1164780144

NPI Information

NPI: 1164780144
Provider Name: PRESENCE AMBULATORY SERVICES

Doing Business As: PRESENCE ADVANCED IMAGING CENTER

Classification: Clinic/Center - 261QR0200X
Entity Type: Organization

Specialization: Radiology

Address:
205 S NORTHWEST HWY
SUITE 120
PARK RIDGE, IL
ZIP 60068
Phone: (847) 292-5200
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PRESENCE AMBULATORY SERVICES is a radiology clinic center in Park Ridge, IL. PRESENCE AMBULATORY SERVICES NPI is 1164780144. The provider is registered as an organization entity type.
The provider Is Doing Business As Presence Advanced Imaging Center.

The provider's business location address is:

205 S NORTHWEST HWY
SUITE 120
PARK RIDGE, IL
ZIP 60068-802
Phone: (847) 292-5200
Fax: (847) 292-5239

The provider's authorized official is Melvonne Wickliffe-jones .
The authorized official title is Credentialing Mgr and has the following contact phone number (630) 914-2417.

The enumeration date for this NPI number is 4/27/2012 and was last updated on 5/29/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0200X	Clinic/Center	Radiology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	IL2940	MEDICARE PIN	ILLINOIS
2	745367	MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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