Basic Information
| Provider Information | |||||||||
| NPI: | 1942778659 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLIED IMAGING CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6301 UNIVERSITY COMMONS STE 230 | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466351590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742512100 | ||||||||
| FaxNumber: | 5742512150 | ||||||||
| Practice Location | |||||||||
| Address1: | 6301 UNIVERSITY COMMONS STE 370 | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466353501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742512100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2018 | ||||||||
| LastUpdateDate: | 02/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROUSSARIE | ||||||||
| AuthorizedOfficialFirstName: | SHERY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5742512100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.