Organization
INDIANA REGIONAL P E T AND IMAGING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIAYONA L TORRES (DIRECTOR)
(219) 793-9655
Entity
Organization
Contact information
Practice address
7891 BROADWAY STE A, MERRILLVILLE, IN 46410-5556
(219) 793-9655
(219) 793-9692
Mailing address
7891 BROADWAY STE A, MERRILLVILLE, IN 46410-5556
(219) 793-9655
(219) 793-9692
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200208560A
—
IN
01
—
318826
ANTHEM
—
Enumeration date
10/13/2006
Last updated
12/05/2012
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