Healthcare Provider Details

I. General information

NPI: 1730061490
Provider Name (Legal Business Name): DIAGNOSTIC CENTERS OF AMERICA LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S SHORE DR
SOUTH LAKE TAHOE CA
96150-4219
US

IV. Provider business mailing address

5775 WAYZATA BLVD STE 400
ST LOUIS PARK MN
55416-1271
US

V. Phone/Fax

Practice location:
  • Phone: 952-905-5602
  • Fax:
Mailing address:
  • Phone: 866-674-7933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMONA L AHERN
Title or Position: SPECIAL ASSISTANT SECRETARY
Credential:
Phone: 952-738-4441