Provider Demographics
NPI:1417479247
Name:CROWN RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:CROWN RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:AIYEVBEKPEN
Authorized Official - Last Name:OSAGIEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-756-4600
Mailing Address - Street 1:602 N HIGH SCHOOL RD STE A2
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3694
Mailing Address - Country:US
Mailing Address - Phone:317-731-6929
Mailing Address - Fax:
Practice Address - Street 1:602 N HIGH SCHOOL RD STE A2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3694
Practice Address - Country:US
Practice Address - Phone:317-731-6929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty