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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