Provider Demographics
NPI:1164829214
Name:METHODIST-CDI
Entity Type:Organization
Organization Name:METHODIST-CDI
Other - Org Name:RAYUS RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-513-6831
Mailing Address - Street 1:5775 WAYZATA BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1222
Mailing Address - Country:US
Mailing Address - Phone:952-543-6500
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:5425 W SPRING CREEK PKWY STE 110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4244
Practice Address - Country:US
Practice Address - Phone:214-778-0100
Practice Address - Fax:214-778-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty