Provider Demographics
NPI:1871740357
Name:MRS MRI OF JOLIET, LLC
Entity type:Organization
Organization Name:MRS MRI OF JOLIET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MELLECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-815-4818
Mailing Address - Street 1:903 129TH INFANTRY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3171
Mailing Address - Country:US
Mailing Address - Phone:815-741-0160
Mailing Address - Fax:
Practice Address - Street 1:903 129TH INFANTRY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3171
Practice Address - Country:US
Practice Address - Phone:815-741-0160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)