Provider Demographics
NPI:1952717852
Name:METRO DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:METRO DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:651-216-6330
Mailing Address - Street 1:1997 SLOAN PL STE 23
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2051
Mailing Address - Country:US
Mailing Address - Phone:651-800-4818
Mailing Address - Fax:651-800-4819
Practice Address - Street 1:1997 SLOAN PL STE 23
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2051
Practice Address - Country:US
Practice Address - Phone:651-800-4818
Practice Address - Fax:651-800-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN62-9106261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile