Provider Demographics
NPI:1053311399
Name:WEST IMAGING, LLC
Entity Type:Organization
Organization Name:WEST IMAGING, LLC
Other - Org Name:MINNEAPOLIS RADIOLOGY-ROBBINSDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-559-2171
Mailing Address - Street 1:2955 XENIUM LN N
Mailing Address - Street 2:SUITE 40
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2666
Mailing Address - Country:US
Mailing Address - Phone:763-559-2171
Mailing Address - Fax:763-398-8701
Practice Address - Street 1:3366 OAKDALE AVE N STE 401
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2986
Practice Address - Country:US
Practice Address - Phone:763-559-2171
Practice Address - Fax:763-398-6601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST IMAGING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-28
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN378552085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1603353OtherMEDICA
MN32543300Medicaid
311L01MIOtherBCBS
MN325433000Medicaid
MNC03346Medicare PIN
C03348Medicare PIN