Provider Demographics
NPI:1205205069
Name:MIDWEST IMAGING LLP
Entity Type:Organization
Organization Name:MIDWEST IMAGING LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUINCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-728-1867
Mailing Address - Street 1:3133 BERWICK KNL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2781 FREEWAY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1765
Practice Address - Country:US
Practice Address - Phone:651-728-1867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN835203700021261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)