Provider Demographics
NPI:1154834091
Name:NOBLE IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:NOBLE IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIN
Authorized Official - Middle Name:HUU
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-488-1666
Mailing Address - Street 1:9716 UPTON AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1012
Mailing Address - Country:US
Mailing Address - Phone:763-923-5655
Mailing Address - Fax:
Practice Address - Street 1:4610 OAK GROVE PKWY N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-4062
Practice Address - Country:US
Practice Address - Phone:763-488-1666
Practice Address - Fax:763-488-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN976334500021261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology