Provider Demographics
NPI:1669642864
Name:DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-280-9096
Mailing Address - Street 1:5021 VERNON AVE SO
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:612-280-9096
Mailing Address - Fax:952-920-2377
Practice Address - Street 1:5021 VERNON AVE SO
Practice Address - Street 2:SUITE 300
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436
Practice Address - Country:US
Practice Address - Phone:612-280-9096
Practice Address - Fax:952-920-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile