Provider Demographics
NPI:1578698833
Name:SOUTH CENTRAL INDIANA RADIOLOGY CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:SOUTH CENTRAL INDIANA RADIOLOGY CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAIB
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:812-523-1140
Mailing Address - Street 1:303 S WALNUT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2368
Mailing Address - Country:US
Mailing Address - Phone:812-523-1140
Mailing Address - Fax:812-523-0991
Practice Address - Street 1:303 S WALNUT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2368
Practice Address - Country:US
Practice Address - Phone:812-523-1140
Practice Address - Fax:812-523-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50001660174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN380750Medicare ID - Type Unspecified