Organization
SUBURBAN XRAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA A BALLARD DC (PRESIDENT)
(630) 529-0077
Entity
Organization
Contact information
Practice address
7 N 130 MEDINAH RD, UNIT A, MEDINAH, IL 60157
(630) 529-0077
(630) 529-0087
Mailing address
PO BOX 471, MEDINAH, IL 60157
(630) 529-0077
(630) 529-0087
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
58494275
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07223234
BLUE CROSS BLUE SHIELD
IL
Enumeration date
02/02/2007
Last updated
08/22/2020
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