Provider Demographics
NPI:1467451641
Name:PROGRESSIVE MEDICAL IMAGING
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-673-0370
Mailing Address - Street 1:PO BOX 6280
Mailing Address - Street 2:DEPT 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6280
Mailing Address - Country:US
Mailing Address - Phone:866-338-6461
Mailing Address - Fax:
Practice Address - Street 1:830 N THEATRE RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1700
Practice Address - Country:US
Practice Address - Phone:765-673-0370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000192996OtherBC BS
IN179810Medicare ID - Type Unspecified