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1053311399

NPI Code Detail

MEDICARE: WEST IMAGING, LLC

MEDICARE: WEST IMAGING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085U0001X	Diagnostic Ultrasound Physician	37855	MN
2	2085R0202X	Diagnostic Radiology Physician	37855	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1603353	OTHER		MEDICA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	311L01MI	OTHER		BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053311399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST IMAGING, LLC

Provider Business Mailing Address
First Line	:	2955 XENIUM LN N
Second Line	:	SUITE 40
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-2666
Country	:	US
Telephone Number	:	763-559-2171
Fax Number	:	763-398-8701

Provider Business Practice Location Address
First Line	:	3366 OAKDALE AVE N STE 401
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-2986
Country	:	US
Telephone Number	:	763-559-2171
Fax Number	:	763-398-6601

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	KRISTEN CARLSON
Credential	:
Telephone Number	:	763-559-2171

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	11/13/2019

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Directions to “WEST IMAGING, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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