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General NPI Number Information
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NPI Number | 1790875706
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Entity Type | Organization
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Legal Business Name | INDIANA MRI, LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 3802 INDUSTRIAL BLVD SUITE 4
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5141
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Country | US
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Telephone | 812-331-7727
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Fax | 812-331-8983
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Provider Business Mailing Address
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Address Line | 3900 S WALNUT ST
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City | BLOOMINGTON
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State | IN
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Zip | 47401-7393
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Country | US
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Telephone | 812-336-0056
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Fax | 812-336-0059
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | OWEN LAUER
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Credential |
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Telephone | 812-336-0056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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