Provider Demographics
NPI:1396791984
Name:WEST CENTRAL RADIOLOGICAL ASSOCIATES, LTD
Entity type:Organization
Organization Name:WEST CENTRAL RADIOLOGICAL ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:OSTBY
Authorized Official - Last Name:SEWALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-262-3344
Mailing Address - Street 1:1101 1ST ST S STE 5
Mailing Address - Street 2:WEST CENTRAL RADIOLOGICAL ASSOCIATES, LTD
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3500
Mailing Address - Country:US
Mailing Address - Phone:320-262-3344
Mailing Address - Fax:320-262-3347
Practice Address - Street 1:1101 1ST ST S STE 5
Practice Address - Street 2:WEST CENTRAL RADIOLOGICAL ASSOCIATES, LTD
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3500
Practice Address - Country:US
Practice Address - Phone:320-262-3344
Practice Address - Fax:320-262-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN768208500Medicaid
MN768208500Medicaid