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

100 Provena Way
Suite 104
Bourbonnais, IL 60914

Phone

(815) 929-5800

Fax

(815) 929-5801

NPI assigned

Aug 30, 2006

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

(815) 806-2309

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": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720197601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5775 WAYZATA BLVD",
            "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": "100 PROVENA WAY",
            "address_2": "SUITE 104",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-929-5800",
            "fax_number": "815-929-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENA IMAGING SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "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": "815-806-2309"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  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 River Counseling and Consulting, LLC
• Prairieview GYN LLC
• Presence Hospitals PRV (Presence St. Mary's Cancer Center)
• Presence Life Connections (Presence Our Lady of Victory Nursing Home)
• Prime Healthcare Home Care LLC
• Provena St Marys Hospital
• Pulmonary & Critical Care Associates of Kankakee LTD
• Pure Growth Counseling PLLC
• Haley Rose Radev
• Radiation Oncology of Kankakee

• Diagnostic Radiology Physician in Bourbonnais, IL
• Providers in Bourbonnais, 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.