Provider Demographics
NPI:1962206771
Name:INDIANA MOBILE RADIOLOGY LLC
Entity type:Organization
Organization Name:INDIANA MOBILE RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISO
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:317-797-1133
Mailing Address - Street 1:3905 VINCENNES RD STE 303
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3030
Mailing Address - Country:US
Mailing Address - Phone:317-827-5058
Mailing Address - Fax:317-471-3508
Practice Address - Street 1:3905 VINCENNES RD STE 303
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3030
Practice Address - Country:US
Practice Address - Phone:317-797-1133
Practice Address - Fax:317-471-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology