Healthcare Provider Details

I. General information

NPI: 1962277277
Provider Name (Legal Business Name): MERIDIAN MAMMOGRAPHY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 N MERIDIAN ST
INDIANAPOLIS IN
46208-4486
US

IV. Provider business mailing address

3524 N MERIDIAN ST
INDIANAPOLIS IN
46208-4486
US

V. Phone/Fax

Practice location:
  • Phone: 317-925-0653
  • Fax:
Mailing address:
  • Phone: 317-925-0653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ELSE COLE
Title or Position: CEO
Credential:
Phone: 317-496-7137