Provider Demographics
NPI:1013361377
Name:FORT WAYNE UPRIGHT MRI, LLC
Entity Type:Organization
Organization Name:FORT WAYNE UPRIGHT MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:ARMRIT
Authorized Official - Phone:260-969-2323
Mailing Address - Street 1:14704 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9304
Mailing Address - Country:US
Mailing Address - Phone:260-503-7269
Mailing Address - Fax:
Practice Address - Street 1:6811 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-1145
Practice Address - Country:US
Practice Address - Phone:260-969-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INXF201770261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)