Healthcare Provider Details

I. General information

NPI: 1366227951
Provider Name (Legal Business Name): LOVE AT FIRST SCAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W BURRELL DR
CROWN POINT IN
46307-8898
US

IV. Provider business mailing address

533 CHARLES CT
CROWN POINT IN
46307-7865
US

V. Phone/Fax

Practice location:
  • Phone: 219-310-8828
  • Fax: 219-333-2123
Mailing address:
  • Phone: 219-508-9883
  • Fax: 219-333-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON P GRIMLEY
Title or Position: OWNER
Credential:
Phone: 219-508-9883