Provider Demographics
NPI:1700276813
Name:NEXTIMAGE MEDICAL
Entity Type:Organization
Organization Name:NEXTIMAGE MEDICAL
Other - Org Name:WORKWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-461-4319
Mailing Address - Street 1:11 E SUPERIOR ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2007
Mailing Address - Country:US
Mailing Address - Phone:866-997-9675
Mailing Address - Fax:
Practice Address - Street 1:11 E SUPERIOR ST
Practice Address - Street 2:SUITE 410
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2007
Practice Address - Country:US
Practice Address - Phone:866-997-9675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management