Healthcare Provider Details

I. General information

NPI: 1447259338
Provider Name (Legal Business Name): NORTHWEST RADIOLOGY NETWORK, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 WOODVIEW TRCE
INDIANAPOLIS IN
46268-3181
US

IV. Provider business mailing address

5901 TECHNOLOGY CENTER DR
INDIANAPOLIS IN
46278-6013
US

V. Phone/Fax

Practice location:
  • Phone: 317-328-3747
  • Fax: 317-489-5166
Mailing address:
  • Phone: 317-328-5050
  • Fax: 317-715-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number50000088
License Number StateIN

VIII. Authorized Official

Name: MELISSA BETH BUTTON
Title or Position: HR MANAGER
Credential:
Phone: 317-328-5050