Provider Demographics
NPI:1427145671
Name:UNIVERSITY RADIOLOGISTS, S.C.
Entity type:Organization
Organization Name:UNIVERSITY RADIOLOGISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-971-1290
Mailing Address - Street 1:PO BOX 776058
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6058
Mailing Address - Country:US
Mailing Address - Phone:217-917-4494
Mailing Address - Fax:630-597-7247
Practice Address - Street 1:701 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62781-0001
Practice Address - Country:US
Practice Address - Phone:217-788-3260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty