Healthcare Provider Details

I. General information

NPI: 1003281262
Provider Name (Legal Business Name): JOSHUA MCALISTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N SENATE AVE STE 100
INDIANAPOLIS IN
46202-3297
US

IV. Provider business mailing address

5350 W SOUTHERN AVE
INDIANAPOLIS IN
46241-5510
US

V. Phone/Fax

Practice location:
  • Phone: 317-472-4565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License NumberXT023665
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: