Provider Demographics
NPI:1104998806
Name:EVERGREEN MOBILE IMAGING, INC
Entity type:Organization
Organization Name:EVERGREEN MOBILE IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-790-3644
Mailing Address - Street 1:799 ROOSEVELT RD
Mailing Address - Street 2:BLDG#3 SUITE#005
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5908
Mailing Address - Country:US
Mailing Address - Phone:630-790-3644
Mailing Address - Fax:630-790-3645
Practice Address - Street 1:799 ROOSEVELT RD
Practice Address - Street 2:BLDG#3 SUITE#005
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5908
Practice Address - Country:US
Practice Address - Phone:630-790-3644
Practice Address - Fax:630-790-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5888140002Medicare NSC