MEDICARE: ARROWHEAD CONSULTATION SERVICE LTD

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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1194725044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARROWHEAD CONSULTATION SERVICE LTD

Provider Business Mailing Address
First Line	:	415 SE 13TH ST
Second Line	:	SUITE 101
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-4248
Country	:	US
Telephone Number	:	218-326-5424
Fax Number	:	218-327-4930

Provider Business Practice Location Address
First Line	:	415 SE 13TH ST
Second Line	:	SUITE 101
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-4248
Country	:	US
Telephone Number	:	218-326-5424
Fax Number	:	218-327-4930

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL NORMAN OLSON
Credential	:	M.D.
Telephone Number	:	218-326-5424

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/22/2020

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