1467467233 NPI number — NORTHERN DIAGNOSTIC SERVICES, INC

Table of content: (NPI 1467467233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467467233 NPI number — NORTHERN DIAGNOSTIC SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN DIAGNOSTIC SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH STAR MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467467233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 9TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55792-2325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-741-0001
Provider Business Mailing Address Fax Number:
218-749-7940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 N 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55792-2279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-741-0001
Provider Business Practice Location Address Fax Number:
218-749-2707
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
LORI
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
BILLING CLERK
Authorized Official Telephone Number:
218-741-0001

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  3896172 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 759884000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9G449NO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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