Provider Demographics
NPI:1427131127
Name:RADIOLOGICAL ASSOCIATES OF DECATUR
Entity type:Organization
Organization Name:RADIOLOGICAL ASSOCIATES OF DECATUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:AGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-753-9323
Mailing Address - Street 1:319 E MADISON SUITE J
Mailing Address - Street 2:RADIOLOGICAL ASSOCIATES OF DECATUR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701
Mailing Address - Country:US
Mailing Address - Phone:217-753-9323
Mailing Address - Fax:217-753-9327
Practice Address - Street 1:319 E MADISON SUITE J
Practice Address - Street 2:SPRINGFIELD MRI & IMAGING CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701
Practice Address - Country:US
Practice Address - Phone:217-528-4770
Practice Address - Fax:217-528-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL739910Medicare PIN
ILCI1102Medicare PIN