Healthcare Provider Details

I. General information

NPI: 1144247719
Provider Name (Legal Business Name): ASA IMAGING OF INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KILGORE AVE
MUNCIE IN
47304
US

IV. Provider business mailing address

3570 N BRIARWOOD LN
MUNCIE IN
47304-5211
US

V. Phone/Fax

Practice location:
  • Phone: 765-741-8843
  • Fax: 765-741-8853
Mailing address:
  • Phone: 765-741-8843
  • Fax: 765-741-8853

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: MRS. ANGELA L EAKINS
Title or Position: DIRECTOR
Credential: BS CRA
Phone: 765-741-8843