Provider Demographics
NPI:1316018161
Name:IMAGINEX P C
Entity Type:Organization
Organization Name:IMAGINEX P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-663-1248
Mailing Address - Street 1:1428 EAST STATE ROAD 46
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240
Mailing Address - Country:US
Mailing Address - Phone:812-663-1248
Mailing Address - Fax:812-662-8283
Practice Address - Street 1:720 N LINCOLN ST
Practice Address - Street 2:DECATUR COUNTY MEMORIAL HOSPITAL, ATTN: RADIOLOGY DEPT
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1327
Practice Address - Country:US
Practice Address - Phone:812-663-1248
Practice Address - Fax:812-663-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200258460AMedicaid
INDB4429OtherRR MEDICARE
IN=========050OtherCARESOURCE
INDB4429OtherRR MEDICARE
IN=========OtherTRICARE
IN=========OtherANTHEM BCBS
IN193770Medicare PIN