Provider Demographics
NPI:1356891568
Name:LIFETIME IMAGING LLC
Entity type:Organization
Organization Name:LIFETIME IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-426-0678
Mailing Address - Street 1:5144 E STOP 11 ROAD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8606
Mailing Address - Country:US
Mailing Address - Phone:317-426-0678
Mailing Address - Fax:
Practice Address - Street 1:5144 E STOP 11 ROAD
Practice Address - Street 2:SUITE 18
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8606
Practice Address - Country:US
Practice Address - Phone:317-426-0678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory