Provider Demographics
NPI:1447252200
Name:NORTHERN INDIANA MAGNETIC RESONANCE CENTER, LLP
Entity type:Organization
Organization Name:NORTHERN INDIANA MAGNETIC RESONANCE CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-272-9991
Mailing Address - Street 1:17333 DUGDALE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1500
Mailing Address - Country:US
Mailing Address - Phone:574-272-9991
Mailing Address - Fax:574-271-9998
Practice Address - Street 1:17333 DUGDALE DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1500
Practice Address - Country:US
Practice Address - Phone:574-272-9991
Practice Address - Fax:574-271-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000103542OtherANTHEM
IN166290Medicare ID - Type UnspecifiedMEDICARE NUMBER