Provider Demographics
NPI:1619903242
Name:MERIDIAN MRI, LLC
Entity Type:Organization
Organization Name:MERIDIAN MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDABACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-706-7246
Mailing Address - Street 1:8805 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2332
Mailing Address - Country:US
Mailing Address - Phone:317-706-7246
Mailing Address - Fax:317-706-3419
Practice Address - Street 1:8805 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2332
Practice Address - Country:US
Practice Address - Phone:317-706-7246
Practice Address - Fax:317-706-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200520060AMedicaid
IN225750Medicare ID - Type UnspecifiedMEDICARE NUMBER