Organization
QUARTER RAD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA JEAN VICARS (OWN PRESIDENT)
(812) 234-4642
Entity
Organization
Contact information
Practice address
2901 OHIO BLVD, SUITE 211, TERRE HAUTE, IN 47803-0211
(812) 234-4642
(812) 234-7314
Mailing address
PO BOX 3553, TERRE HAUTE, IN 47803-0553
(812) 234-4642
(812) 234-7314
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
XF200934
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000237630
BCBS
—
01
—
1471377
FUNDS
—
01
—
149850
MCIL
—
05
—
200533000A
—
IN
01
—
630000648
PALMETTO
—
Enumeration date
01/29/2007
Last updated
08/20/2009
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