Healthcare Provider Details

I. General information

NPI: 1922061613
Provider Name (Legal Business Name): MRI CENTER - FORT WAYNE RADIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 CAREW ST
FORT WAYNE IN
46805-4712
US

IV. Provider business mailing address

3707 NEW VISION DR
FORT WAYNE IN
46845-1702
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-9127
  • Fax: 260-484-5919
Mailing address:
  • Phone: 260-471-9466
  • Fax: 260-484-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES M RAUSCH JR.
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 260-471-9466