Healthcare Provider Details

I. General information

NPI: 1679528194
Provider Name (Legal Business Name): SHARED MEDICAL TECHNOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 HWY 59 SE
THIEF RIVER FALLS MN
56701
US

IV. Provider business mailing address

202 W NEWTON ST
RICE LAKE WI
54868-1627
US

V. Phone/Fax

Practice location:
  • Phone: 218-681-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG ZADRA
Title or Position: CEO
Credential:
Phone: 715-234-6518