Provider Demographics
NPI:1720030034
Name:IRVINGTON RADIOLOGISTS PC
Entity Type:Organization
Organization Name:IRVINGTON RADIOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING/MANAGED CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BILBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-579-2150
Mailing Address - Street 1:7340 SHADELAND STA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3979
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-806-8296
Practice Address - Street 1:7340 SHADELAND STA
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3979
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-806-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100282500AMedicaid
IN100282500AMedicaid