Provider Demographics
NPI:1578513065
Name:FORTUNE ENTERPRISES, INC
Entity Type:Organization
Organization Name:FORTUNE ENTERPRISES, INC
Other - Org Name:PREVIEW ULTRASOUND STUDIOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-569-2229
Mailing Address - Street 1:301 E CARMEL DR
Mailing Address - Street 2:STE. D200
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2888
Mailing Address - Country:US
Mailing Address - Phone:317-569-2229
Mailing Address - Fax:866-437-9987
Practice Address - Street 1:301 E CARMEL DR
Practice Address - Street 2:STE. D200
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2888
Practice Address - Country:US
Practice Address - Phone:317-569-2229
Practice Address - Fax:866-437-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INNA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INAPPLYINGMedicaid
INAPPLYINGMedicaid