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NPI Code Detail

MEDICARE: DIAGNOSTIC IMAGING OF IN PC

MEDICARE: DIAGNOSTIC IMAGING OF IN PC
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
12085R0202XDiagnostic Radiology Physician01034289AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CB0039OTHERTRAVELERS
2000000012713OTHERENCORE
31414OTHERPHP
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5000000084887OTHERINBCBS

General Provider Information

NPI Number : 1619951233
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAGNOSTIC IMAGING OF IN PC
Provider Business Mailing Address
First Line : PO BOX 11086
Second Line :
City : FORT WAYNE
State : IN
Zip : 46855-1086
Country : US
Telephone Number : 314-821-8055
Fax Number : 314-821-1833
Provider Business Practice Location Address
First Line : 2101 DUBOIS DR
Second Line :
City : WARSAW
State : IN
Zip : 46580-3210
Country : US
Telephone Number : 574-267-3200
Fax Number : 314-821-1833
Authorized Official
Title or Position : DIRECTOR OF RADIOLOGY
Name : STEVEN L HOSSLER
Credential : M.D.
Telephone Number : 574-267-3200
Provider Enumeration Date : 12/06/2005
Last Update Date : 08/22/2020

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Directions to “DIAGNOSTIC IMAGING OF IN PC ” Practice Location

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