# SUBURBAN XRAY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467590471
- **Authorized official:** PAMELA A BALLARD DC (PRESIDENT)
- **Authorized official phone:** (630) 529-0077

## Contact information

- **Practice address:** 7 N 130 MEDINAH RD, UNIT A, MEDINAH, IL 60157
- **Practice address phone:** (630) 529-0077
- **Practice address fax:** (630) 529-0087
- **Mailing address:** PO BOX 471, MEDINAH, IL 60157
- **Mailing address phone:** (630) 529-0077
- **Mailing address fax:** (630) 529-0087

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 58494275 | IL | Yes |

## Other

- **Enumeration date:** 02/02/2007
- **Last updated:** 08/22/2020