Bloomington Radiology S C
Radiology, Diagnostic Radiology in Normal, IL. Organization (NPI-2).
NPI number1700831773
StatusActive
Last updated in NPPESMay 27, 2021
Details
- NPI
- 1700831773
- Entity type
- Organization (NPI-2)
- Legal business name
- Bloomington Radiology S C
- Organization subpart
- No
- Enumeration date
- May 24, 2006
- Certification date
- May 27, 2021
- Last updated
- May 27, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085R0202X | Radiology, Diagnostic Radiology | 042001755 | IL | Yes |
| 2085B0100X | Radiology, Body Imaging | 042001755 | IL | |
| 2085N0700X | 042001755 | IL | ||
| 2085N0904X | 042001755 | IL | ||
| 2085R0204X | Radiology, Vascular & Interventional Radiology | 042001755 | IL |
Practice location
2200 Fort Jesse RdSuite 280
Normal, IL 61761-6286
Phone 309-452-1788 · Fax 309-862-1302
Mailing address
Po Box 3668Bloomington, IL 61702-3668
Phone 309-452-1788 · Fax 309-862-1302
Authorized official
Ajay Malpani
President
3094521788
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