Provider Demographics
NPI:1942778659
Name:ALLIED IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:ALLIED IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSARIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-251-2100
Mailing Address - Street 1:6301 UNIVERSITY COMMONS STE 230
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1590
Mailing Address - Country:US
Mailing Address - Phone:574-251-2100
Mailing Address - Fax:574-251-2150
Practice Address - Street 1:6301 UNIVERSITY COMMONS STE 370
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-3501
Practice Address - Country:US
Practice Address - Phone:574-251-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty