=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699072611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMAGING ASSOCIATES OF INDIANA, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2011
-----------------------------------------------------
Last Update Date | 09/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 S MAIN ST ATTN: RADIOLOGY DEPARTMENT
-----------------------------------------------------
City | CROWN POINT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46307-8481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-767-6320
-----------------------------------------------------
Fax | 219-738-6714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 208807
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75320-8807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-501-6087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | SHARLEE LEBLEU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-321-7026
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | NONE
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | NONE
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------