Organization
MARION MEDICAL XRAY
Active
Other names
MARION MEDICAL XRAY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY KAY BRANDON (OFFICE MANAGER)
(618) 997-6909
Entity
Organization
Contact information
Practice address
1008 W CHERRY ST, MARION, IL 62959-1998
(618) 997-6909
(618) 997-7759
Mailing address
1008 W CHERRY ST, MARION, IL 62959-1998
(618) 997-6909
(618) 997-7759
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360443201
—
IL
01
—
1052274
UMWA
IL
01
—
164921
FDA
IN
01
—
271836
HEALTHLINK
—
01
—
2800075
BLUE CROSS BLUE SHIELD
IL
01
—
693272
MEDICARE GROUP PROVIDER #
IL
01
—
863211
DEPT OF LABOR
IL
Enumeration date
12/01/2006
Last updated
12/19/2007
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