Organization
SHARED IMAGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND STACHOWIAK (PRESIDENT)
(630) 483-3980
Entity
Organization
Contact information
Practice address
2801 MEDICAL CENTER DR, POCAHONTAS, AR 72455-9436
(630) 483-3980
(630) 483-3986
Mailing address
801 PHOENIX LAKE AVE, STREAMWOOD, IL 60107-2363
(630) 483-3980
(630) 483-3986
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5F825
MEDICARE
AR
Enumeration date
02/14/2007
Last updated
01/14/2008
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