Provider Demographics
NPI:1306873377
Name:PRI DIAGNOSTICS, LLC.
Entity type:Organization
Organization Name:PRI DIAGNOSTICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ERBES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-277-0936
Mailing Address - Street 1:22285 PEPPER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-277-0936
Mailing Address - Fax:847-277-0945
Practice Address - Street 1:1456 MOMENTUM PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60689-5314
Practice Address - Country:US
Practice Address - Phone:847-277-0936
Practice Address - Fax:847-277-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01195492261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL221093Medicare ID - Type UnspecifiedGROUP NUMBER