# INNERVISION ADVANCED MEDICAL IMAGING CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649543141
- **Authorized official:** MARTHA K MILLER (DIRECTOR OF BILLING)
- **Authorized official phone:** (765) 446-5417

## Contact information

- **Practice address:** 1411 S CREASY LANE, SUITE 130, LAFAYETTE, IN 47905-7433
- **Practice address phone:** (765) 447-7447
- **Practice address fax:** (765) 446-5317
- **Mailing address:** PO BOX 4699, LAFAYETTE, IN 47903-4699
- **Mailing address phone:** (765) 449-2732
- **Mailing address fax:** (765) 446-5317

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085B0100X | Body Imaging Physician | — | NULL | Yes |
| 2085B0100X | Body Imaging Physician | — | — | Yes |
| 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