Provider Demographics
NPI:1063450542
Name:PROSCAN IMAGING OF INDIANAPOLIS, LLC
Entity Type:Organization
Organization Name:PROSCAN IMAGING OF INDIANAPOLIS, LLC
Other - Org Name:PROSCAN IMAGING OF CARMEL
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 1:1185 W CARMEL DR
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8706
Mailing Address - Country:US
Mailing Address - Phone:317-706-1700
Mailing Address - Fax:317-706-1705
Practice Address - Street 1:1185 W CARMEL DR
Practice Address - Street 2:SUITE D-1
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8706
Practice Address - Country:US
Practice Address - Phone:317-706-1700
Practice Address - Fax:317-706-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000477513OtherANTHEM PIN
000000477513OtherANTHEM PIN
IN247580Medicare PIN