Organization
RADIOLOGY, INC
Active
Other names
Radiology, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
JOLEEN M HOLOBYN (PROVIDER ENROLLMENT COORDINATOR)
(574) 258-1100
Entity
Organization
Contact information
Practice address
620 W EDISON RD, SUITE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Mailing address
620 W EDISON RD, SUITE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100220290
—
IN
Enumeration date
09/01/2005
Last updated
07/19/2011
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