Provider Demographics
NPI:1467467233
Name:NORTHERN DIAGNOSTIC SERVICES, INC
Entity Type:Organization
Organization Name:NORTHERN DIAGNOSTIC SERVICES, INC
Other - Org Name:NORTH STAR MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-741-0001
Mailing Address - Street 1:901 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2325
Mailing Address - Country:US
Mailing Address - Phone:218-741-0001
Mailing Address - Fax:218-749-7940
Practice Address - Street 1:1001 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2279
Practice Address - Country:US
Practice Address - Phone:218-741-0001
Practice Address - Fax:218-749-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3896172332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN759884000Medicaid
MN9G449NOOtherBLUE CROSS BLUE SHIELD
MN9G449NOOtherBLUE CROSS BLUE SHIELD