Healthcare Provider Details

I. General information

NPI: 1679799811
Provider Name (Legal Business Name): ALLIED DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N MAIN ST
MISHAWAKA IN
46545-3110
US

IV. Provider business mailing address

3838 N MAIN ST
MISHAWAKA IN
46545-3110
US

V. Phone/Fax

Practice location:
  • Phone: 574-968-4100
  • Fax: 574-968-4125
Mailing address:
  • Phone: 574-968-4100
  • Fax: 574-968-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICK HIBBOTT
Title or Position: ADMINISTRATOR
Credential:
Phone: 708-926-5396