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Organization
INNERVISION ADVANCED MEDICAL IMAGING CENTER, LLC
Active
Organization
INNERVISION ADVANCED MEDICAL IMAGING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA K MILLER (DIRECTOR OF BILLING)
(765) 446-5417
Entity
Organization
Contact information
Practice address
1411 S CREASY LANE, SUITE 130, LAFAYETTE, IN 47905-7433
(765) 447-7447
(765) 446-5317
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 446-5317
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
—
NULL
2085B0100X
Body Imaging Physician
Primary
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
NULL
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Enumeration date
02/14/2012
Last updated
02/14/2012
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