Provider Demographics
NPI:1205944717
Name:VINCENNES RADIOLOGY, INC.
Entity type:Organization
Organization Name:VINCENNES RADIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MALNAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-882-6717
Mailing Address - Street 1:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-7466
Mailing Address - Country:US
Mailing Address - Phone:812-882-6717
Mailing Address - Fax:812-882-8620
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-885-3351
Practice Address - Fax:812-882-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN443010Medicare PIN