MEDICARE: INDIANA RADIOLOGY PARTNERS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	1223X0008X	Oral and Maxillofacial Radiology Dentistry	IN
2	2085B0100X	Body Imaging Physician
3	2085N0700X	Neuroradiology Physician
4	2085N0904X	Nuclear Radiology Physician
5	2085R0204X	Vascular & Interventional Radiology Physician
6	2085U0001X	Diagnostic Ultrasound Physician
7	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1497712160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA RADIOLOGY PARTNERS, INC

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:	317-962-4836
Fax Number	:	317-962-8646

Provider Business Practice Location Address
First Line	:	714 N SENATE AVE
Second Line	:	SUITE EF 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3763
Country	:	US
Telephone Number	:	317-962-4836
Fax Number	:	317-962-8646

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RANDALL J LUCKEY
Credential	:
Telephone Number	:	317-962-4836

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	11/05/2007

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