Provider Demographics
NPI:1730632209
Name:PREFERRED OPEN MRI LTD
Entity type:Organization
Organization Name:PREFERRED OPEN MRI LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-581-5600
Mailing Address - Street 1:4200 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5010
Mailing Address - Country:US
Mailing Address - Phone:773-581-5600
Mailing Address - Fax:773-581-5608
Practice Address - Street 1:1550 TODD FARM DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1287
Practice Address - Country:US
Practice Address - Phone:847-841-8500
Practice Address - Fax:847-841-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========0Medicaid