Provider Demographics
NPI:1578835237
Name:AMERICAN IMAGING AND MRI, LLC
Entity type:Organization
Organization Name:AMERICAN IMAGING AND MRI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKIE-DEE
Authorized Official - Middle Name:GARDNER
Authorized Official - Last Name:BARTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-662-0100
Mailing Address - Street 1:2716 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-3574
Mailing Address - Country:US
Mailing Address - Phone:765-662-0100
Mailing Address - Fax:765-662-0101
Practice Address - Street 1:2716 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-3574
Practice Address - Country:US
Practice Address - Phone:765-662-0100
Practice Address - Fax:765-662-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036335A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN150021C000913Medicare PIN