Advantage MRI-Carol Stream, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

ADVANTAGE MRI-CAROL STREAM, LLC

Practice address

640 E Saint Charles Rd
Suite 106
Carol Stream, IL 60188-3083

Phone

(630) 462-0793

Fax

(630) 462-1376

NPI assigned

Aug 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Stephanie Tucker

Title

Director

Phone

(630) 755-4327

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508371200000",
    "number": "1265626436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 BUTTERFIELD RD STE 219S",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231239",
            "telephone_number": "630-755-4327",
            "fax_number": "630-819-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 E SAINT CHARLES RD",
            "address_2": "SUITE 106",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601883083",
            "telephone_number": "630-462-0793",
            "fax_number": "630-462-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE MRI-CAROL STREAM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-30",
        "last_updated": "2017-10-19",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "630-755-4327",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.