| Organization Name: | FORT WAYNE UPRIGHT MRI, LLC |
| NPI Number: | 1013361377 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KAYLA J STOINSKI (MANAGER) |
| Mailing Address: | 6811 Lima Rd Fort Wayne |
| State: | IN US |
| Postal Code: | 468181145 |
| Phone Number: | 2609692323 |
| Fax Number: | |
| NPI Enumeration Date: | 04/22/2016 |
| NPI Last Update Date: | 04/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1200X |
| License Number: | XF201770 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Magnetic Resonance Imaging (MRI) |
| Taxonomy Definition: | |