PROVENA IMAGING SERVICES INC (NPI# 1720197601) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720197601 |
| Entity Type | Organization |
| Organization Name | PROVENA IMAGING SERVICES INC |
| Other Organization Name | PROVENA HEALTH CENTER FOR DIAGNOSTIC IMAGING |
| Practice Address |
100 Provena Way Suite 104 Bourbonnais IL 60914 |
| Mailing Address |
5775 Wayzata Blvd Suite 400 St Louis Park MN 55416 |
| Practice Telephone | 8159295800 |
| Practice Fax Number | 8159295801 |
| Mailing Telephone | 9525428553 |
| Mailing Fax Number | 9525136880 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | EDWARD MOLARE (PRESIDENT) |
| Authorized Official Telephone | 8158062309 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Provena Health Center for Diagnostic Imaging | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649383910 | Provena Imaging Services Inc | Radiology | 1416c South Randall Road, Geneva, IL 60134 | 2006-08-17 |
| Street Address |
100 PROVENA WAY SUITE 104 |
| City | BOURBONNAIS |
| State | IL |
| Zip Code | 60914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700867496 | Radiation Oncology of Kankakee | Radiology | 100 Provena Way, Suite 102, Bourbonnais, IL 60914-4796 | 2005-11-09 |
| 1922287358 | Ludag LLC, Dba Cancer Treatment Group | Radiology | 100 Provena Way, Bourbonnais, IL 60914-4796 | 2007-11-02 |
| 1740477900 | Kankakee Radiation Oncology LLC | Radiology | 100 Provena Way, Suite 102, Bourbonnais, IL 60914-4796 | 2007-10-01 |
| 1215141627 | Presence Hospitals Prv | Internal Medicine | 100 Provena Way, Suite 103, Bourbonnais, IL 60914-4796 | 2007-05-09 |
| 1033245683 | Margaret Comfort | Physician Assistant | 100 Provena Way, Suite 103, Bourbonnais, IL 60914 | 2007-02-26 |
| 1659406510 | Suresh H Wadhwani | Internal Medicine | 100 Provena Way, Bourbonnais, IL 60914-4796 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648023 | Jacob Daniel Ledesma | Physical Therapist | 588 William R Latham Senior Dr Ste 5, Bourbonnais, IL 60914 | 2020-10-30 |
| 1467069823 | Alicia Nicole Kendra | Nurse Practitioner | Upliftedcare, 482 Main St. Nw, Bourbonnais, IL 60914 | 2020-09-29 |
| 1043860877 | Victor Manuel Vazquez Cervantes | Pharmacist | 2080 No, Il-50, Bourbonnais, IL 60914 | 2019-09-13 |
| 1740843267 | Panoptic Physical Therapy LLC | Physical Medicine & Rehabilitation | 1511 N. Convent St Suite 1000, Bourbonnais, IL 60914 | 2019-04-19 |
| 1770074577 | Colin P Koerner | Physical Therapist | 215 N Convent St Ste 6, Bourbonnais, IL 60914 | 2018-05-29 |
| 1306337340 | Megan Hoskins | Behavior Technician | 3187 N 2420 W Rd., Bourbonnais, IL 60914 | 2018-05-25 |
| 1932600459 | Thomas H George Dds PC | Clinic/Center | 14 Briarcliff Professional Center, Bourbonnais, IL 60914 | 2018-02-21 |
| 1780193904 | Kathleen M Saindon II | Speech-Language Pathologist | 1021 Deer Trail, Bourbonnais, IL 60914 | 2017-09-20 |
| 1457870206 | Janet Mary Notton | Speech-Language Pathologist | 920 W Margaret Lane, Bourbonnais, IL 60914 | 2017-09-13 |
| 1134646375 | Sagar Batish | Student in an Organized Health Care Education/Training Program | 1096 Country Lane, Bourbonnais, IL 60914 | 2017-08-28 |
| Find all providers in zip 60914 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376196220 | Parvathamma Imaging Services, LLC | Radiology | 7431 S East End Ave Ste 2, Chicago, IL 60649-3611 | 2019-07-19 |
| 1730652017 | Diaspora Radiology, Sc | Radiology | 2602 Mulberry Ln, Northbrook, IL 60062-5937 | 2019-01-09 |
| 1225516842 | Tyler Jonathan Hinkel | Radiology | 33 W Ontario St Apt 46f, Chicago, IL 60654 | 2018-08-06 |
| 1043796543 | Quantum Medical Radiology of California, P.C. | Radiology | 374 W Seminary Ave, Wheaton, IL 60187-5002 | 2018-07-17 |
| 1215429501 | The Open Mri Center | Radiology | 3123 Williamson County Pkwy, Marion, IL 62959-5235 | 2018-06-01 |
| 1649769746 | Envision Medical Imaging, LLC | Radiology | 915 National Pkwy Ste 915-20, Schaumburg, IL 60173-5160 | 2018-05-03 |
| 1831687250 | Michael Patrick Murphy | Radiology | 807 Davis St. Unit 707, Evanston, IL 60201 | 2018-05-01 |
| 1366976631 | Ali Mostafa Serhal | Radiology | 240 E. Huron St, Suite 1-203, Chicago, IL 60617 | 2017-04-13 |
| 1710427737 | Dorothea A Nazos | Radiology | 1810 Parkside Dr, Shorewood, IL 60404-0684 | 2017-02-24 |
| 1194275941 | Florida United Radiology, Lc | Radiology | 7 Pear Tree Ct, Charleston, IL 61920-4415 | 2016-10-05 |
| Find all providers with the same taxonomy | ||||
| City | BOURBONNAIS |
| Zip Code | 60914 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.