Organization
TRI COUNTY RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. W ROBERT COOPER (CMPE, CHBC)
(309) 682-7750
Entity
Organization
Contact information
Practice address
5409 N KNOXVILLE AVE, PEORIA, IL 61615
(309) 682-7750
(309) 682-7786
Mailing address
PO BOX 3853, PEORIA, IL 61612-3853
(800) 899-5757
(314) 821-1833
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007222342
BLUE CROSS BLUE SHIELD
IL
01
—
IL0100
JOHN DEERE
IL
Enumeration date
01/04/2006
Last updated
09/11/2025
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