Basic Information
| Provider Information | |||||||||
| NPI: | 1487745253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOSS | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E 25TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183123002 | ||||||||
| FaxNumber: | 2182638933 | ||||||||
| Practice Location | |||||||||
| Address1: | 1924 DUNEDIN AVE | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558032400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187246083 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MN44231 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 44321 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1602543 | 01 | MN | MEDICA | OTHER | 164104 | 01 | MN | UCARE | OTHER | H100320262 | 01 | MN | MEDICARE | OTHER | P00043495 | 01 | MN | RAILROAD MEDICARE | OTHER | 087K5NO | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |