Healthcare Provider Details

I. General information

NPI: 1699140129
Provider Name (Legal Business Name): MEDICAL IMAGING NORTH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E BELTLINE
HIBBING MN
55746-4504
US

IV. Provider business mailing address

1200 E 25TH ST
HIBBING MN
55746-3897
US

V. Phone/Fax

Practice location:
  • Phone: 855-748-4200
  • Fax:
Mailing address:
  • Phone: 218-312-3002
  • Fax: 218-263-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL L COURNEYA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 218-966-5241