Healthcare Provider Details

I. General information

NPI: 1538405477
Provider Name (Legal Business Name): COLUMBUS DIAGNOSTIC IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CREEKVIEW DR
COLUMBUS IN
47201-2606
US

IV. Provider business mailing address

790 CREEKVIEW DR
COLUMBUS IN
47201-2606
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-1000
  • Fax:
Mailing address:
  • Phone: 812-376-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: RHONDA LENNON
Title or Position: MANAGER
Credential:
Phone: 812-376-1000