Provider Demographics
NPI:1619916954
Name:IMAGING CENTER OF NORTH CENTRAL INDIANA, INC.
Entity Type:Organization
Organization Name:IMAGING CENTER OF NORTH CENTRAL INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELIUSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:1765-453-8404
Mailing Address - Street 1:2201 WEST BOULVARD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-0607
Mailing Address - Country:US
Mailing Address - Phone:765-452-0808
Mailing Address - Fax:756-455-1711
Practice Address - Street 1:2201 WEST BLVD.
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902
Practice Address - Country:US
Practice Address - Phone:765-452-0808
Practice Address - Fax:756-455-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN224110Medicare ID - Type UnspecifiedPAR PROVIDER NUMBER