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NILES OPEN MRI INC
Complete NPI Record 1720211360
Clinic/Center - Magnetic Resonance Imaging (MRI) in Niles, IL

NPI Status: Active since August 31, 2009

Contact Information

8618 W GOLF RD
NILES, IL
ZIP 60714
Phone: (847) 824-2628
Fax: (847) 824-4157

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Title or Position
  24. Authorized Official Telephone Number
  25. Healthcare Provider Taxonomy Code 1
  26. Provider License Number State Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Is Organization Subpart
  29. Authorized Official Name Prefix Text

Complete NPI Dataset

This page represents the complete record for NPI 1720211360. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1720211360
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider First Line Business Mailing Address: PO BOX 7389
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: PROSPECT HEIGHTS
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address State Name: IL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 600707389
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 8478242628
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Fax Number: 8478244157
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 8618 W GOLF RD
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Business Practice Location Address City Name: NILES
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: IL
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 607145600
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number: 8478242628
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8478244157
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/31/2009
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/31/2009
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Last Name: NELLAMATTATHIL
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: GIGY
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official Title or Position: DIRECTOR
The title or position of the authorized official.
Authorized Official Telephone Number: 8478242628
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QM1200X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number State Code 1: IL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Authorized Official Name Prefix Text: MS.