Provider Demographics
NPI:1508533878
Name:GREEN RIVER RADIOLOGY, P.C.
Entity Type:Organization
Organization Name:GREEN RIVER RADIOLOGY, P.C.
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:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-738-4441
Mailing Address - Street 1:5775 WAYZATA BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1271
Mailing Address - Country:US
Mailing Address - Phone:866-674-7933
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:10696 S RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3525
Practice Address - Country:US
Practice Address - Phone:801-563-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty