Provider Demographics
NPI:1093772527
Name:RADIOLOGY ASSOCIATES PROF, LLC
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES PROF, LLC
Other - Org Name:DAKOTA RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-380-8060
Mailing Address - Street 1:PO BOX 860211
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0211
Mailing Address - Country:US
Mailing Address - Phone:605-342-2852
Mailing Address - Fax:605-342-3930
Practice Address - Street 1:2929 5TH ST.
Practice Address - Street 2:STE 100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7355
Practice Address - Country:US
Practice Address - Phone:605-342-2852
Practice Address - Fax:605-342-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S2Medicare ID - Type Unspecified