Organization
MIDWEST X-RAY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDY L ASHBY RT (RADIOLOGY MANAGER)
(812) 491-1307
Entity
Organization
Contact information
Practice address
1031 MOUNT AUBURN RD, EVANSVILLE, IN 47720-8226
(812) 425-4682
(812) 425-2564
Mailing address
1031 MOUNT AUBURN RD, EVANSVILLE, IN 47720-8226
(812) 425-4682
(812) 425-2564
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
20453
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000226088
ANTHEM PROVIDER#
IN
01
—
0002222230
BC BS IL PROVIDER#
IL
05
—
200311880A
—
IN
Enumeration date
12/26/2006
Last updated
09/14/2020
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