Provider Demographics
NPI:1548201452
Name:1012 INVESTMENTS, LLC
Entity Type:Organization
Organization Name:1012 INVESTMENTS, LLC
Other - Org Name:MIDWEST RADIOLOGYOFF INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GANOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-557-6165
Mailing Address - Street 1:9120 S COUNTY ROAD 800 W
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47334-9421
Mailing Address - Country:US
Mailing Address - Phone:317-557-6165
Mailing Address - Fax:317-595-6050
Practice Address - Street 1:9120 S COUNTY ROAD 800 W
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:IN
Practice Address - Zip Code:47334-9421
Practice Address - Country:US
Practice Address - Phone:317-557-6165
Practice Address - Fax:317-595-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00361771OtherRAILROAD MEDICARE
IN247040Medicare PIN