| Indiana University Radiology Associates Inc | |
|
250 N Shadeland Ave Ste 200 Indianapolis IN 46219-4959 | |
| (317) 962-4836 | |
| (317) 962-4391 |
| Full Name | Indiana University Radiology Associates Inc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Radiology |
| Location | 250 N Shadeland Ave, Indianapolis, Indiana |
| Authorized Official Name and Position | Randall J Luckey (SECRETARY, TREASURER) |
| Authorized Official Contact | 3174724565 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana University Radiology Associates Inc 714 N Senate Ave Ste 100 Indianapolis IN 46202-3763 Ph: (317) 962-4836 | Indiana University Radiology Associates Inc 250 N Shadeland Ave Ste 200 Indianapolis IN 46219-4959 Ph: (317) 962-4836 |
| NPI Number | 1376889568 |
|---|---|
| Provider Enumeration Date | 12/17/2012 |
| Last Update Date | 06/05/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376889568 | NPI | - | NPPES |
| 201129790 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12010577 (Indiana) | Secondary |
| 1223X0008X | Dentist - Oral And Maxillofacial Radiology | 12010577 (Indiana) | Primary |
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