Provider Demographics
NPI:1275945925
Name:RADIOLOGY MEDICAL CONSULTANTS OF INDIANA
Entity Type:Organization
Organization Name:RADIOLOGY MEDICAL CONSULTANTS OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-350-4403
Mailing Address - Street 1:250 E CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2635
Mailing Address - Country:US
Mailing Address - Phone:317-350-4403
Mailing Address - Fax:317-282-0589
Practice Address - Street 1:250 E CARMEL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2635
Practice Address - Country:US
Practice Address - Phone:317-350-4403
Practice Address - Fax:317-282-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069842A261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201248990AMedicaid
MIF11303Medicare UPIN
IN201248990AMedicaid