Provider Demographics
NPI:1609392349
Name:RAI KEYSTONE IMAGING SERVICES, LLC
Entity Type:Organization
Organization Name:RAI KEYSTONE IMAGING SERVICES, LLC
Other - Org Name:CENTER FOR DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-525-6338
Mailing Address - Street 1:5775 WAYZATA BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1271
Mailing Address - Country:US
Mailing Address - Phone:952-525-6338
Mailing Address - Fax:952-905-5697
Practice Address - Street 1:5775 WAYZATA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1271
Practice Address - Country:US
Practice Address - Phone:952-525-6338
Practice Address - Fax:952-905-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty