Provider Demographics
NPI:1508295320
Name:MOBILE DIAGNOSTICS OF INDIANA
Entity Type:Organization
Organization Name:MOBILE DIAGNOSTICS OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:317-488-9581
Mailing Address - Street 1:1070 E 86TH ST
Mailing Address - Street 2:SUITE 72D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1862
Mailing Address - Country:US
Mailing Address - Phone:317-488-9581
Mailing Address - Fax:
Practice Address - Street 1:1070 E 86TH ST
Practice Address - Street 2:SUITE 72D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1862
Practice Address - Country:US
Practice Address - Phone:317-488-9581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization