Radiologic Interpretations of Southern Illinois LTD

Primary specialty

Radiologic TechnologistTaxonomy code 247100000X

Legal business name

RADIOLOGIC INTERPRETATIONS OF SOUTHERN ILLINOIS LTD

Practice address

1200 Cedar Court
Carbondale, IL 62901-5334

Phone

(618) 529-8500

Fax

(618) 549-1000

NPI assigned

Mar 5, 2007

Last updated

Nov 12, 2015By 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

Dr. Douglas L Fulk, MDNPI 1992780050

Title

President

Phone

(618) 529-8500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Douglas L Fulk, M.D.

  • Diagnostic Radiology Physician
  • Carbondale, IL
  • NPI 1992780050

  MO

  Medicare reassignment NPD Authorized official
• Daniel Raymond Fulk, D.O.

  • Diagnostic Radiology Physician
  • Carbondale, IL
  • NPI 1962432286

  MO

  Medicare reassignment NPD

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447286400000",
    "number": "1730218652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CEDAR COURT",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015334",
            "telephone_number": "618-529-8500",
            "fax_number": "618-549-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CEDAR COURT",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015334",
            "telephone_number": "618-529-8500",
            "fax_number": "618-549-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGIC INTERPRETATIONS OF SOUTHERN ILLINOIS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2015-11-12",
        "status": "A",
        "authorized_official_last_name": "FULK",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-529-8500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiologic Technologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Elizabeth Prudencio, LCSW
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• Shawn Wayne Pyle, CRNA
• Debra Renee Queen, R.D.
• Gloria Queriapa-Valdes, BAS, CD (DONA)
• Michael Rafati, MD
• Rainbow Cafe Lgbtq Center (Rainbow Community Health & Wellness)
• Srinivas Rajamahanty, M.D.
• Daniel Ralls, PA
• Susan M Ramirez, PH.D.

• Radiologic Technologist in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Radiologic Technologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.