Provider Demographics
NPI:1184663544
Name:EAST CENTRAL RADIOLOGY
Entity Type:Organization
Organization Name:EAST CENTRAL RADIOLOGY
Other - Org Name:IMAGING CENTER OF EAST CENTRAL INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DAUNHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-282-7595
Mailing Address - Street 1:2598 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-5251
Mailing Address - Country:US
Mailing Address - Phone:765-282-7595
Mailing Address - Fax:765-288-0737
Practice Address - Street 1:2598 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-5251
Practice Address - Country:US
Practice Address - Phone:765-282-7595
Practice Address - Fax:765-288-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INXF201156261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200151170Medicaid
IN200151170AMedicaid
IN200151170Medicaid