Organization
INDIANA MRI OF LAFAYETTE LLC
Active
Other names
Open MRI of Lafayette
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE DOUGLAS (CREDENTIALING MANAGER)
(502) 403-1401
Entity
Organization
Contact information
Practice address
130 PROFESSIONAL CT, STE C, LAFAYETTE, IN 47905-5153
(765) 449-7984
(765) 449-9791
Mailing address
130 PROFESSIONAL CT, STE C, LAFAYETTE, IN 47905-5153
(765) 449-7984
(765) 449-9791
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200134270
—
IN
Enumeration date
05/23/2005
Last updated
06/12/2008
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