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General NPI Number Information
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NPI Number | 1306898168
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Entity Type | Organization
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Legal Business Name | TRI-STATE MEDICAL IMAGING CENTER, LLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 3250 INTERTECH PARKWAY SUITE D
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City | ANGOLA
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State | IN
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Zip | 46703-7223
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Country | US
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Telephone | 260-665-3200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5602
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City | FORT WAYNE
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State | IN
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Zip | 46895-5602
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Country | US
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Telephone | 260-471-9466
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. MICHAEL A KINZER
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Credential | M.D.
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Telephone | 260-471-9466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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