MEDICARE: NORTHWEST RADIOLOGY NETWORK P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	50000088	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447259338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST RADIOLOGY NETWORK P C

Provider Business Mailing Address
First Line	:	5901 TECHNOLOGY CENTER DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-6013
Country	:	US
Telephone Number	:	317-328-5050
Fax Number	:	317-715-9965

Provider Business Practice Location Address
First Line	:	3502 WOODVIEW TRCE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3181
Country	:	US
Telephone Number	:	317-328-3747
Fax Number	:	317-489-5166

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TRACY PRINCE
Credential	:
Telephone Number	:	480-594-3884

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	04/13/2026

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