Organization
SALEM FLORA RADIOLOGY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PREECHA TAWJAREON M.D. (OWNER, PRESIDENT)
(618) 548-2843
Entity
Organization
Contact information
Practice address
815 W MAIN ST, SALEM, IL 62881-1408
(618) 548-2843
(618) 548-2896
Mailing address
815 W MAIN ST, P.O. BOX 875, SALEM, IL 62881-1408
(618) 548-2843
(618) 548-2896
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006115210
BLUECROSS BLUESHIELD
IL
01
—
CF1003
RAILROAD MEDICARE
IL
01
—
L06343
SALEM PIN #
IL
01
—
P04756
FLORA PIN #
IL
Enumeration date
03/05/2007
Last updated
04/20/2008
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