Excellent Diagnostic Imaging Center, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

EXCELLENT DIAGNOSTIC IMAGING CENTER, LLC

Practice address

14489 John Humphrey Dr
Suite 1-SC
Orland Park, IL 60462-2637

Phone

(708) 364-1205

Fax

(708) 364-1265

NPI assigned

Jun 22, 2011

Organization subpart

No

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

Authorized official

Name

Ahsin Shamsi

Title

Administrator

Phone

(708) 364-1205

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664582400000",
    "number": "1629364252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14489 JOHN HUMPHREY DR",
            "address_2": "SUITE 1-SC",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604622637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14489 JOHN HUMPHREY DR",
            "address_2": "SUITE 1-SC",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604622637",
            "telephone_number": "708-364-1205",
            "fax_number": "708-364-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELLENT DIAGNOSTIC IMAGING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2022-10-01",
        "certification_date": "2022-10-01",
        "status": "A",
        "authorized_official_last_name": "SHAMSI",
        "authorized_official_first_name": "AHSIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "708-364-1205"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Orland Park, IL
• Providers in Orland Park, IL by specialty
• General Practice Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2022; 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.