Healthcare Provider Details

I. General information

NPI: 1043338171
Provider Name (Legal Business Name): MEDICAL IMAGING NORTH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 11/12/2015
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: 218-312-3002
  • Fax:
Mailing address:
  • Phone: 218-312-3002
  • Fax: 218-312-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL COURNEYA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 218-312-3005