Provider Demographics
NPI:1902957830
Name:APOLLO XRAY SERVICES INC
Entity Type:Organization
Organization Name:APOLLO XRAY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT
Authorized Official - Phone:847-657-1200
Mailing Address - Street 1:3633 W LAKE AVE
Mailing Address - Street 2:LL6
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5805
Mailing Address - Country:US
Mailing Address - Phone:847-657-1200
Mailing Address - Fax:847-657-1187
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:LL6
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-657-1200
Practice Address - Fax:847-657-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2471B0102X, 2471C3402X, 2471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Multi-Specialty
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Not Answered2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50000559OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid
IL=========001Medicaid