PROVENA IMAGING SERVICES INC; NPI #1720197601

Contact Information

PROVENA IMAGING SERVICES INC

100 PROVENA WAY
SUITE 104
BOURBONNAIS, IL 60914

Phone: 815-929-5800
Fax: 815-929-5801
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Diagnostic Radiology	2085R0202X	30	Physician/Diagnostic Radiology

Indicates primary specialty

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NPI Profile & details for PROVENA IMAGING SERVICES INC

NPI #	`1720197601`
LBN Legal business name	PROVENA IMAGING SERVICES INC
Authorized official	EDWARD MOLARE - (PRESIDENT)
Entity	Organization
Organization subpart ¹	No
Enumeration date	08/30/2006
Last updated	08/22/2020 - About 6 years ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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PROVENA IMAGING SERVICES INC

Contact Information

Specialty

Diagnostic Radiology

NPI Profile & details for PROVENA IMAGING SERVICES INC

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