Berwyn Imaging LLC

Primary specialty

Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X

Legal business name

BERWYN IMAGING LLC

Practice address

6728 Cermak Rd
Berwyn, IL 60402-2217

Phone

(708) 788-8900

Fax

(708) 788-5110

NPI assigned

May 25, 2016

Organization subpart

No

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

Authorized official

Name

Marvin Tazelaar

Title

Director

Phone

(630) 333-4674

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• WESTERN OPEN MRI Doing business as

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

{
    "created_epoch": "1464134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1922456474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6728 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022217",
            "telephone_number": "708-788-8900",
            "fax_number": "708-788-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6728 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022217",
            "telephone_number": "708-788-8900",
            "fax_number": "708-788-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERWYN IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-25",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "TAZELAAR",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "630-333-4674"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TELEPHONE",
            "identifier": "7087888900",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WESTERN OPEN MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Magnetic Resonance Imaging (MRI) Clinic/Center in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Magnetic Resonance Imaging (MRI) Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.