Healthcare Provider Details

I. General information

NPI: 1598921074
Provider Name (Legal Business Name): PELLA IMAGING CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 JEFFERSON ST
PELLA IA
50219-1257
US

IV. Provider business mailing address

166 4TH ST E
SAINT PAUL MN
55101-1421
US

V. Phone/Fax

Practice location:
  • Phone: 641-621-2347
  • Fax: 641-628-7241
Mailing address:
  • Phone: 651-292-2000
  • Fax: 651-292-2178

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: LEE F HENRY
Title or Position: CEO
Credential: MD
Phone: 641-621-2347