Provider Demographics
NPI:1831254424
Name:MIDWEST X-RAY, INC
Entity type:Organization
Organization Name:MIDWEST X-RAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:812-491-1307
Mailing Address - Street 1:1031 MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-8226
Mailing Address - Country:US
Mailing Address - Phone:812-425-4682
Mailing Address - Fax:812-425-2564
Practice Address - Street 1:1031 MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-8226
Practice Address - Country:US
Practice Address - Phone:812-425-4682
Practice Address - Fax:812-425-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20453335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000226088OtherANTHEM PROVIDER#
IL0002222230OtherBC BS IL PROVIDER#
IN200311880AMedicaid
IL0002222230OtherBC BS IL PROVIDER#
IN000000226088OtherANTHEM PROVIDER#