Provider Demographics
NPI:1356458475
Name:MOBILE IMAGING SERVICES, LLC
Entity Type:Organization
Organization Name:MOBILE IMAGING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MYHRA-BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-573-2200
Mailing Address - Street 1:1221 NICOLLET MALL
Mailing Address - Street 2:STE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:2000 ABBOTT NW CT
Practice Address - Street 2:STE 115
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377
Practice Address - Country:US
Practice Address - Phone:320-534-2100
Practice Address - Fax:320-534-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty