Healthcare Provider Details

I. General information

NPI: 1053311399
Provider Name (Legal Business Name): WEST IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 OAKDALE AVE N STE 401
ROBBINSDALE MN
55422-2986
US

IV. Provider business mailing address

2955 XENIUM LN N SUITE 40
PLYMOUTH MN
55441-2666
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-2171
  • Fax: 763-398-6601
Mailing address:
  • Phone: 763-559-2171
  • Fax: 763-398-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number37855
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number37855
License Number StateMN

VIII. Authorized Official

Name: KRISTEN CARLSON
Title or Position: CREDENTIALING
Credential:
Phone: 763-559-2171