MEDICARE: MIDWEST X-RAY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	20453	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000226088	OTHER	IN	ANTHEM PROVIDER#
2	0002222230	OTHER	IL	BC BS IL PROVIDER#
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831254424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST X-RAY, INC

Provider Business Mailing Address
First Line	:	1031 MOUNT AUBURN RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-8226
Country	:	US
Telephone Number	:	812-425-4682
Fax Number	:	812-425-2564

Provider Business Practice Location Address
First Line	:	1031 MOUNT AUBURN RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-8226
Country	:	US
Telephone Number	:	812-425-4682
Fax Number	:	812-425-2564

Authorized Official
Title or Position	:	RADIOLOGY MANAGER
Name	:	MS. SANDY L ASHBY
Credential	:	RT
Telephone Number	:	812-491-1307

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	09/14/2020

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Directions to “MIDWEST X-RAY, INC ” Practice Location

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