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Organization
INDIANA MRI OF TERRE HAUTE, LLC
Active
Organization
INDIANA MRI OF TERRE HAUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OWEN LAUER (MANAGING MEMBER)
(812) 336-0056
Entity
Organization
Contact information
Practice address
4313 S 7TH ST, TERRE HAUTE, IN 47802-4365
(812) 234-0555
(812) 235-2973
Mailing address
3900 S WALNUT ST, BLOOMINGTON, IN 47401-7393
(812) 336-0056
(812) 336-0059
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221954
ANTHEM
IN
05
—
100473160A
—
IN
Enumeration date
10/13/2006
Last updated
04/03/2012
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