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General NPI Number Information
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NPI Number | 1538205422
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Entity Type | Organization
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Legal Business Name | QUARTER RAD INC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 2901 OHIO BLVD SUITE 211
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City | TERRE HAUTE
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State | IN
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Zip | 47803-0211
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Country | US
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Telephone | 812-234-4642
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Fax | 812-234-7314
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Provider Business Mailing Address
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Address Line | PO BOX 3553
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City | TERRE HAUTE
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State | IN
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Zip | 47803-0553
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Country | US
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Telephone | 812-234-4642
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Fax | 812-234-7314
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Authorized Official
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Title or Position | OWN PRESIDENT
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Name | MONICA JEAN VICARS
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Credential |
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Telephone | 812-234-4642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | XF200934
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License Number State | IN
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