Healthcare Provider Details

I. General information

NPI: 1720030034
Provider Name (Legal Business Name): IRVINGTON RADIOLOGISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 SHADELAND STA SUITE 200
INDIANAPOLIS IN
46256-3979
US

IV. Provider business mailing address

7340 SHADELAND STA SUITE 200
INDIANAPOLIS IN
46256-3979
US

V. Phone/Fax

Practice location:
  • Phone: 317-579-2150
  • Fax: 317-806-8296
Mailing address:
  • Phone: 317-579-2150
  • Fax: 317-806-8296

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: MS. MARTHA J BILBEE
Title or Position: DIRECTOR OF BILLING/MANAGED CARE
Credential:
Phone: 317-579-2150