Basic Information
| Provider Information | |||||||||
| NPI: | 1356458475 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILE IMAGING SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 NICOLLET MALL | ||||||||
| Address2: | STE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732200 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 ABBOTT NW CT | ||||||||
| Address2: | STE 115 | ||||||||
| City: | SARTELL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205342100 | ||||||||
| FaxNumber: | 3205342104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 09/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | MYHRA-BLOOM | ||||||||
| AuthorizedOfficialFirstName: | KARLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | RADIOLOGY | ||||||||
| AuthorizedOfficialTelephone: | 6125732200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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.