Organization
CLINICAL RADIOLOGISTS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS C DICKERSON (CHIEF EXECUTIVE OFFICER)
(217) 222-9302
Entity
Organization
Contact information
Practice address
295 FOX DR, BOULDER, CO 80303-3529
(952) 595-5296
Mailing address
3050 MONTVALE DR, SPRINGFIELD, IL 62704-4290
(217) 726-8096
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
042000749
IL
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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