Basic Information
| Provider Information | |||||||||
| NPI: | 1245283266 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL STATES IMAGING LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RAYUS RADIOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1450 | ||||||||
| Address2: | NW5710 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554855710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525428553 | ||||||||
| FaxNumber: | 9525136880 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 CEDAR RIDGE DRIVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LAKE IN THE HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474586736 | ||||||||
| FaxNumber: | 8474586700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | HOLMAN | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | SPECIAL ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9525136831 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.