Provider Demographics
NPI:1043338171
Name:MEDICAL IMAGING NORTH PA
Entity Type:Organization
Organization Name:MEDICAL IMAGING NORTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COURNEYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-312-3005
Mailing Address - Street 1:1200 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3897
Mailing Address - Country:US
Mailing Address - Phone:218-312-3002
Mailing Address - Fax:218-312-3003
Practice Address - Street 1:2900 E BELTLINE
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-4504
Practice Address - Country:US
Practice Address - Phone:218-312-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103198OtherUCARE
MN782012700Medicaid
MNCD6182OtherRAILROAD MEDICARE
MN69531MEOtherBLUE CROSS BLUE SHIELD
MNC08043Medicare PIN