Organization
SOUTHERN ILLINOIS IMAGING ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D. O'BRIEN (AUTHORIZED OFFICIAL)
(513) 281-3400
Entity
Organization
Contact information
Practice address
509 HAMACHER ST, SUITE 300, WATERLOO, IL 62298-1592
(618) 939-9790
Mailing address
509 HAMACHER ST, SUITE 300, WATERLOO, IL 62298-1592
(618) 939-9790
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06732037
BC/BS PIN
IL
01
—
7829963
AETNA PIN
—
Enumeration date
09/28/2006
Last updated
01/28/2008
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