Provider Demographics
NPI:1154553253
Name:MBS IMAGING LLC
Entity type:Organization
Organization Name:MBS IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIRWAJID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-613-9590
Mailing Address - Street 1:1919 S. HIGHLAND AVENUE, BUILDING 'C' SUITE 100
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6134
Mailing Address - Country:US
Mailing Address - Phone:877-495-7152
Mailing Address - Fax:877-495-7208
Practice Address - Street 1:1919 S. HIGHLAND AVENUE
Practice Address - Street 2:BUILDING 'C' SUITE 100
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6134
Practice Address - Country:US
Practice Address - Phone:877-495-7152
Practice Address - Fax:877-495-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-22
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000OtherINSURANCE