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Ambulatory Health Care Facilities Clinic/Center Radiology, Mobile Mammography

Provider NPI: 1972156214

Organization Information:
Organization is not Subpart
Authorized Official:  MARY  COCKERHAM  CHIEF OPERATING OFFICER  317-626-1720

Practice Location:
Tel: 317-626-1720  Fax: --

Business Mailing Address:
Tel: 317-626-1720  Fax: --

NPI Information:
NPI: 1972156214
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y261QR0207XAmbulatory Health Care Facilities
Radiology, Mobile Mammography

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 261QR0207X





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