Provider Demographics
NPI:1659397784
Name:HEALTHCARE CAMPUS IMAGING ONE, LLC
Entity Type:Organization
Organization Name:HEALTHCARE CAMPUS IMAGING ONE, LLC
Other - Org Name:IMAGING ONE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:JUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:507-332-4731
Mailing Address - Street 1:200 STATE AVE
Mailing Address - Street 2:P.O. BOX 392
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6339
Mailing Address - Country:US
Mailing Address - Phone:507-332-4870
Mailing Address - Fax:507-332-4729
Practice Address - Street 1:200 STATE AVE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6339
Practice Address - Country:US
Practice Address - Phone:507-332-4870
Practice Address - Fax:507-332-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)