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General NPI Number Information
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NPI Number | 1801895081
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Entity Type | Organization
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Legal Business Name | MARION GENERAL RADIOLOGY, INC.
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 441 N WABASH AVE
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City | MARION
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State | IN
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Zip | 46952-2612
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Country | US
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Telephone | 800-288-8325
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Fax | 419-866-5453
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Provider Business Mailing Address
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Address Line | 830 N BALDWIN AVE
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City | MARION
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State | IN
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Zip | 46952-2542
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Country | US
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Telephone | 800-288-8325
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Fax | 419-866-5453
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN DEAN
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Credential | MD
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Telephone | 800-288-8325
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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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