Organization
DIAGNOSTIC IMAGING OF IN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN L HOSSLER M.D. (DIRECTOR OF RADIOLOGY)
(574) 267-3200
Entity
Organization
Contact information
Practice address
2101 DUBOIS DR, WARSAW, IN 46580-3210
(574) 267-3200
(314) 821-1833
Mailing address
PO BOX 11086, FORT WAYNE, IN 46855-1086
(314) 821-8055
(314) 821-1833
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01034289A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000012713
ENCORE
—
01
—
000000084887
BCBS
IN
05
—
0682426
—
OH
01
—
1414
PHP
—
01
—
CB0039
TRAVELERS
—
Enumeration date
12/06/2005
Last updated
08/22/2020
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