Organization
IMAGING DIAGNOSTIC CENTER LIMITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK WILLIAM SCHAEFER (EXECUTIVE DIRECTOR)
(260) 435-7898
Entity
Organization
Contact information
Practice address
7900 W JEFFERSON BLVD STE 101, FORT WAYNE, IN 46804-4128
(260) 432-1568
(260) 432-4969
Mailing address
6119 W JEFFERSON BLVD, IMAGING DIAGNOSTIC CENTER, FORT WAYNE, IN 46804-3072
(260) 432-1568
(260) 432-4969
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0753475
—
OH
05
—
0787251
—
OH
05
—
100081420
—
IN
01
—
CA8912
MEDICARE RAILROAD
IN
Enumeration date
01/31/2006
Last updated
07/01/2008
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