Organization
ASSOCIATED ST JAMES RADIOLOGISTS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGG S COCCARO M.D. (PRESIDENT)
(708) 756-1000
Entity
Organization
Contact information
Practice address
1423 CHICAGO RD, RADIOLOGY DEPARTMENT, CHICAGO HEIGHTS, IL 60411-3400
(708) 756-1000
Mailing address
1423 CHICAGO RD, RADIOLOGY DEPARTMENT, CHICAGO HEIGHTS, IL 60411-3400
(708) 756-1000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1618334
BCBS ID
IL
01
—
CA8284
RAILROAD
IL
01
—
N244858
HARMONY
IL
Enumeration date
09/13/2006
Last updated
12/30/2010
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