Provider Demographics
NPI:1235507773
Name:COMMUNITY IMAGING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:COMMUNITY IMAGING ASSOCIATES, LLC
Other - Org Name:COMMUNITY BREAST SCREENING/XRAY-WASHINGTON SQUARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:FOHRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-621-9366
Mailing Address - Street 1:7340 SHADELAND STA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3979
Mailing Address - Country:US
Mailing Address - Phone:317-355-4990
Mailing Address - Fax:317-355-1712
Practice Address - Street 1:10122 E 10TH ST STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3046
Practice Address - Country:US
Practice Address - Phone:317-355-4990
Practice Address - Fax:317-355-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory