Provider Demographics
NPI:1972693695
Name:NORTHWEST INDIANA PET/CT CENTER
Entity type:Organization
Organization Name:NORTHWEST INDIANA PET/CT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIAYONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-395-9272
Mailing Address - Street 1:1505 S CALUMET RD STE 7-8
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3390
Mailing Address - Country:US
Mailing Address - Phone:219-395-9272
Mailing Address - Fax:219-395-9309
Practice Address - Street 1:1505 S CALUMET RD STE 7-8
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3390
Practice Address - Country:US
Practice Address - Phone:219-395-9272
Practice Address - Fax:219-395-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN229810Medicare ID - Type Unspecified