Organization
GALESBURG RADIOLOGY ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUBBIA JAGANNATHAN M.D. (PRESIDENT)
(877) 852-4669
Entity
Organization
Contact information
Practice address
695 N KELLOGG ST, GALESBURG, IL 61401-2807
(877) 852-4669
Mailing address
PO BOX 1093, BEDFORD PARK, IL 60499-1093
(877) 852-4669
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04815047
BLUE CROSS BLUE SHIELD
IL
01
—
CM2090
RAILROAD MEDICARE
IL
Enumeration date
07/09/2006
Last updated
05/12/2011
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