Provider Demographics
NPI:1922560267
Name:NORTH STAR MOBILE X-RAY LLC
Entity Type:Organization
Organization Name:NORTH STAR MOBILE X-RAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-388-3300
Mailing Address - Street 1:12 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1891
Mailing Address - Country:US
Mailing Address - Phone:718-388-3300
Mailing Address - Fax:
Practice Address - Street 1:6300 SHINGLE CREEK PKWY STE 135
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55430-2124
Practice Address - Country:US
Practice Address - Phone:800-749-9729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile