Provider Demographics
NPI:1205166915
Name:MEDPRO IMAGING MOBILE SERVICES, LLC
Entity type:Organization
Organization Name:MEDPRO IMAGING MOBILE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDEND/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT
Authorized Official - Phone:630-425-0088
Mailing Address - Street 1:1710 N RANDALL RD STE 360
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9406
Mailing Address - Country:US
Mailing Address - Phone:630-987-8744
Mailing Address - Fax:
Practice Address - Street 1:1710 N RANDALL RD STE 360
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9406
Practice Address - Country:US
Practice Address - Phone:630-797-0895
Practice Address - Fax:888-987-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4434Medicare UPIN