Provider Demographics
NPI:1952354292
Name:MEDICAL IMAGING CENTER , LLC IU RADIOLOGY @ NIFS
Entity type:Organization
Organization Name:MEDICAL IMAGING CENTER , LLC IU RADIOLOGY @ NIFS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-274-3960
Mailing Address - Street 1:550 N MERIDIAN ST
Mailing Address - Street 2:STE. 114
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1208
Mailing Address - Country:US
Mailing Address - Phone:317-274-3960
Mailing Address - Fax:317-274-5168
Practice Address - Street 1:250 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5137
Practice Address - Country:US
Practice Address - Phone:317-472-4560
Practice Address - Fax:317-287-8906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201040Medicare PIN