Organization
ILLINI MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES E BRUHN (CEO)
(309) 792-4265
Entity
Organization
Contact information
Practice address
801 ILLINI DR, SILVIS, IL 61282-1804
(309) 792-9363
(563) 421-3419
Mailing address
801 ILLINI DR, SILVIS, IL 61282-1804
(309) 792-9363
(563) 421-3419
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0813286
BLUE CROSS ILLINOIS
IL
01
—
634002
HEALTHLINK
—
01
—
90359
IOWA BLUE CROSS
IA
01
—
IL0100
JOHN DEERE HEALTHCARE
IL
Enumeration date
05/23/2006
Last updated
07/21/2022
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