Provider Demographics
NPI:1487692844
Name:TRIUMPH RADIOLOGY, INC.
Entity type:Organization
Organization Name:TRIUMPH RADIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELLAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-741-4148
Mailing Address - Street 1:1640 WILLOW CIRCLE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0959
Mailing Address - Country:US
Mailing Address - Phone:815-741-4148
Mailing Address - Fax:815-741-4686
Practice Address - Street 1:1640 WILLOW CIRCLE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0959
Practice Address - Country:US
Practice Address - Phone:815-741-4148
Practice Address - Fax:815-741-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200557Medicare ID - Type Unspecified