Provider Demographics
NPI:1699072611
Name:IMAGING ASSOCIATES OF INDIANA, PC
Entity type:Organization
Organization Name:IMAGING ASSOCIATES OF INDIANA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-321-7026
Mailing Address - Street 1:PO BOX 208807
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8807
Mailing Address - Country:US
Mailing Address - Phone:888-501-6087
Mailing Address - Fax:
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8481
Practice Address - Country:US
Practice Address - Phone:219-767-6320
Practice Address - Fax:219-738-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INNONE2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201016500 A-FMedicaid
IN201016500 A-FMedicaid