Provider Demographics
NPI:1609829720
Name:XRC MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:XRC MEDICAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-233-3123
Mailing Address - Street 1:53940 CARMICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1564
Mailing Address - Country:US
Mailing Address - Phone:574-243-0100
Mailing Address - Fax:574-243-2965
Practice Address - Street 1:53940 CARMICHAEL DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1564
Practice Address - Country:US
Practice Address - Phone:574-243-0100
Practice Address - Fax:574-243-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN187390Medicare ID - Type Unspecified