Provider Demographics
NPI:1124196241
Name:WASHINGTON IMAGING LLC
Entity Type:Organization
Organization Name:WASHINGTON IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEN PTR
Authorized Official - Prefix:
Authorized Official - First Name:EUNG
Authorized Official - Middle Name:MAN
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-254-2760
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0701
Mailing Address - Country:US
Mailing Address - Phone:812-254-2760
Mailing Address - Fax:812-882-8620
Practice Address - Street 1:1314 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2860
Practice Address - Country:US
Practice Address - Phone:812-254-2760
Practice Address - Fax:812-882-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010481802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200114270AMedicaid
IN200114270AMedicaid