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General NPI Number Information
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NPI Number | 1619951233
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC IMAGING OF IN PC
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2101 DUBOIS DR
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City | WARSAW
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State | IN
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Zip | 46580-3210
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Country | US
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Telephone | 574-267-3200
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Fax | 314-821-1833
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Provider Business Mailing Address
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Address Line | PO BOX 11086
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City | FORT WAYNE
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State | IN
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Zip | 46855-1086
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Country | US
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Telephone | 314-821-8055
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Fax | 314-821-1833
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Authorized Official
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Title or Position | DIRECTOR OF RADIOLOGY
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Name | STEVEN L HOSSLER
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Credential | M.D.
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Telephone | 574-267-3200
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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 | 01034289A
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License Number State | IN
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