Healthcare Provider Details

I. General information

NPI: 1578958690
Provider Name (Legal Business Name): NWI MOBILE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 MELTON RD
GARY IN
46403-2920
US

IV. Provider business mailing address

5925 MELTON RD
GARY IN
46403-2920
US

V. Phone/Fax

Practice location:
  • Phone: 219-427-1101
  • Fax: 219-939-8743
Mailing address:
  • Phone: 219-427-1101
  • Fax: 219-939-8743

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 Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIE SUE TEAGUE
Title or Position: OWNER
Credential:
Phone: 219-427-1101