1144207101 NPI number — MUNSTER RADIOLOGY GROUP PC

Table of content: (NPI 1144207101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144207101 NPI number — MUNSTER RADIOLOGY GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUNSTER RADIOLOGY GROUP PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144207101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10907
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46411-0907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-379-8731
Provider Business Mailing Address Fax Number:
614-771-2248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
MUNSTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46321-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-836-4569
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUSTAITIS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-836-2022

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0205X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100158170 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".