Provena Imaging Services Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

PROVENA IMAGING SERVICES INC

Doing business as

Provena Health Center for Diagnostic Imaging

Practice address

1416C South Randall Road
Geneva, IL 60134

Phone

(630) 208-9325

Fax

(630) 208-9326

NPI assigned

Aug 17, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edward Molare

Title

President

Phone

(952) 525-6338

Specialties & licenses 1

Addresses

Other names 1

• Provena Health Center for Diagnostic Imaging Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Mercy Medical Center - Aurora LLC

  dba Prime Healthcare Rx 1005

  • Community/Retail Pharmacy
  • Aurora, IL
  • NPI 1215025762

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649383910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5775 WAYZATA BOULEVARD",
            "address_2": "SUITE 400",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "952-542-8553",
            "fax_number": "952-513-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416C SOUTH RANDALL ROAD",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "60134",
            "telephone_number": "630-208-9325",
            "fax_number": "630-208-9326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENA IMAGING SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOLARE",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-525-6338"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provena Health Center for Diagnostic Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prairie Path Podiatry, P.C.
• Jeanna Pritchett, MA
• Elizabeth Proctor, L. AC., DIPL. OM
• Kelsey Proctor
• Arthur Proust, M.D.
• Provena Senior Services (Provena Geneva Care Center)
• Michelle Pytel, PTA
• Sharon Pytel, NP-C
• Elliot Quast, D.C.
• Faaria Quraishi

• Diagnostic Radiology Physician in Geneva, IL
• Providers in Geneva, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.