Provider Demographics
NPI:1558338996
Name:NORTHERN IMAGING OF DULUTH LLC
Entity Type:Organization
Organization Name:NORTHERN IMAGING OF DULUTH LLC
Other - Org Name:ST LUKES CENTER FOR DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER (CFO)
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-543-6504
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:NW 7612
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-7612
Mailing Address - Country:US
Mailing Address - Phone:218-722-5390
Mailing Address - Fax:218-722-7501
Practice Address - Street 1:930 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-722-5390
Practice Address - Fax:218-722-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty