Provider Demographics
NPI:1417091695
Name:SCOTTSBURG RADIOLOGY ASSOCIATES PSC
Entity Type:Organization
Organization Name:SCOTTSBURG RADIOLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEERA
Authorized Official - Middle Name:D
Authorized Official - Last Name:UMMAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-752-4662
Mailing Address - Street 1:1451 N GARDNER ST RM 201
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-7751
Mailing Address - Country:US
Mailing Address - Phone:812-752-4662
Mailing Address - Fax:812-752-4662
Practice Address - Street 1:1451 N GARDNER ST RM 201
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7751
Practice Address - Country:US
Practice Address - Phone:812-752-4662
Practice Address - Fax:812-752-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN730760Medicare PIN