Provider Demographics
NPI:1447259338
Name:NORTHWEST RADIOLOGY NETWORK, P.C.
Entity type:Organization
Organization Name:NORTHWEST RADIOLOGY NETWORK, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-328-5050
Mailing Address - Street 1:5901 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6013
Mailing Address - Country:US
Mailing Address - Phone:317-328-5050
Mailing Address - Fax:317-715-9965
Practice Address - Street 1:3502 WOODVIEW TRCE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3181
Practice Address - Country:US
Practice Address - Phone:317-328-3747
Practice Address - Fax:317-489-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN500000882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100402910Medicaid
IN026010Medicare PIN