Basic Information
| Provider Information | |||||||||
| NPI: | 1124196241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON IMAGING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 701 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475010701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122542760 | ||||||||
| FaxNumber: | 8128828620 | ||||||||
| Practice Location | |||||||||
| Address1: | 1314 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475012860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122542760 | ||||||||
| FaxNumber: | 8128828620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 10/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHA | ||||||||
| AuthorizedOfficialFirstName: | EUNG | ||||||||
| AuthorizedOfficialMiddleName: | MAN | ||||||||
| AuthorizedOfficialTitleorPosition: | GEN PTR | ||||||||
| AuthorizedOfficialTelephone: | 8122542760 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 01048180 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 200114270A | 05 | IN | MEDICAID |