NPIMap

Organization Active NPI

Prairie Creek Radiology,Inc

  • Diagnostic Radiology Physician
  • Terre Haute, IN
National Provider Identifier
1265572838
Registry record updated Apr 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
01031856A Issued in IN
Legal business name
PRAIRIE CREEK RADIOLOGY,INC
Practice address
3901 S 7TH St
Terre Haute, IN 47802-5709
Phone
(812) 234-8261
Fax
(812) 234-8262
NPI assigned
Feb 6, 2007
Last updated
Apr 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Farouk E Mercho, MD
Title
Medical Director
Phone
(812) 234-4642

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 01031856A IN Primary

Addresses

Primary practice location

3901 S 7TH St
Terre Haute, IN 47802-5709

Mailing address

PO Box 2125
Indianapolis, IN 46206-2125
Phone (812) 234-8261

Other identifiers 1

IdentifierTypeStateIssuer
000000242179OtherINBLUE CROSS/BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207699200000",
    "number": "1265572838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2125",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462062125",
            "telephone_number": "812-234-8261",
            "fax_number": "812-234-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 S 7TH ST",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478025709",
            "telephone_number": "812-234-8261",
            "fax_number": "812-234-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE CREEK RADIOLOGY,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2008-04-09",
        "status": "A",
        "authorized_official_last_name": "MERCHO",
        "authorized_official_first_name": "FAROUK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "812-234-4642",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01031856A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "000000242179",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Terre Haute, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.