Provider Demographics
NPI:1538335740
Name:TRIUMPH RADIOLOGY INC
Entity type:Organization
Organization Name:TRIUMPH RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHELLAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-741-4148
Mailing Address - Street 1:1802 DIVISON ST
Mailing Address - Street 2:SUITE 605
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3133
Mailing Address - Country:US
Mailing Address - Phone:815-741-4148
Mailing Address - Fax:815-741-4686
Practice Address - Street 1:2121 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6544
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:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL244359261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214912Medicare UPIN