Organization
INDIANA MRI OF EVANSVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OWEN LAUER (MANAGING MEMBER)
(812) 336-0056
Entity
Organization
Contact information
Practice address
729 JOHN ST, EVANSVILLE, IN 47713-2754
(812) 428-3440
(812) 463-5238
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
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221914
ANTHEM
IN
05
—
200077780A
—
IN
Enumeration date
10/13/2006
Last updated
12/07/2007
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