Provider Demographics
NPI:1386622355
Name:SOUTHWEST HOSPITALS MRI, INC.
Entity type:Organization
Organization Name:SOUTHWEST HOSPITALS MRI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:COIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-636-3290
Mailing Address - Street 1:5550 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5012
Mailing Address - Country:US
Mailing Address - Phone:708-636-0633
Mailing Address - Fax:708-636-0633
Practice Address - Street 1:5550 W 111TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5012
Practice Address - Country:US
Practice Address - Phone:708-636-0633
Practice Address - Fax:708-636-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL772050Medicare ID - Type Unspecified
IL=========001Medicaid