Provider Demographics
NPI:1043370174
Name:PROSCAN IMAGING OF INDIANAPOLIS, LLC
Entity Type:Organization
Organization Name:PROSCAN IMAGING OF INDIANAPOLIS, LLC
Other - Org Name:PROSCAN IMAGING OF AVON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-281-3400
Mailing Address - Street 1:5250 E US HIGHWAY 36
Mailing Address - Street 2:PRESTWICK POINTE SUITE 220
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9199
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5250 E US HIGHWAY 36
Practice Address - Street 2:PRESTWICK POINTE SUITE 220
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9199
Practice Address - Country:US
Practice Address - Phone:317-745-3200
Practice Address - Fax:317-745-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000477513OtherANTHEM PIN
IN247600Medicare PIN
P00406411Medicare PIN