Healthcare Provider Details

I. General information

NPI: 1811994197
Provider Name (Legal Business Name): RADIOLOGY CONSULTANTS OF SE INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8909
US

IV. Provider business mailing address

PO BOX 42796
CINCINNATI OH
45242-0796
US

V. Phone/Fax

Practice location:
  • Phone: 513-965-8041
  • Fax: 513-965-8091
Mailing address:
  • Phone: 513-965-8041
  • Fax: 513-965-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LYNN GRAY
Title or Position: MRG
Credential:
Phone: 513-965-8041