Organization
INDIANA MRI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OWEN LAUER (MANAGING MEMBER)
(812) 336-0056
Entity
Organization
Contact information
Practice address
3802 INDUSTRIAL BLVD, SUITE 4, BLOOMINGTON, IN 47403-5141
(812) 331-7727
(812) 331-8983
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
—
000000221951
ANTHEM
IN
05
—
100185020A
—
IN
Enumeration date
10/13/2006
Last updated
12/07/2007
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