1316018161 NPI number — IMAGINEX P C

Table of content: (NPI 1316018161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316018161 NPI number — IMAGINEX P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMAGINEX P C
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:
1316018161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1428 EAST STATE ROAD 46
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-663-1248
Provider Business Mailing Address Fax Number:
812-662-8283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 N LINCOLN ST
Provider Second Line Business Practice Location Address:
DECATUR COUNTY MEMORIAL HOSPITAL, ATTN: RADIOLOGY DEPT
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47240-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-663-1248
Provider Business Practice Location Address Fax Number:
812-663-1233
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-663-1248

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200258460A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB4429 . This is a "RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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