1659339216 NPI number — CONSULTING RADIOLOGISTS, LTD

Table of content: MS. DIANE A. SHEPPARD MSW, LSW, MAC (NPI 1578775490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659339216 NPI number — CONSULTING RADIOLOGISTS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTING RADIOLOGISTS, LTD
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:
Provider Other Organization Name Type Code:
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:
1659339216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7595 ANAGRAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55344-7399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-573-2200
Provider Business Mailing Address Fax Number:
612-573-2250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6525 FRANCE AVE S
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-285-3720
Provider Business Practice Location Address Fax Number:
952-285-3738
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUCE
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
612-573-2200

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , with the licence number:  322 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X , with the licence number: 322 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X , with the licence number: 322 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X , with the licence number: 322 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 322 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X , with the licence number: 322 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 322 , 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: CG5296 . This is a "RR MEDICARE GROUP NUMBER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 102255 . This is a "UCARE GROUP NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 12934 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0984658 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 587708300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC7547 . This is a "RR MEDICARE GROUP NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7201020 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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