Healthcare Provider Details

I. General information

NPI: 1518911528
Provider Name (Legal Business Name): NORTHERN DIAGNOSTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 9TH AVE N
VIRGINIA MN
55792-2279
US

IV. Provider business mailing address

901 9TH ST N
VIRGINIA MN
55792-2325
US

V. Phone/Fax

Practice location:
  • Phone: 218-749-9410
  • Fax: 218-749-7940
Mailing address:
  • Phone: 218-749-9410
  • Fax: 218-749-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number347924
License Number StateMN

VIII. Authorized Official

Name: MS. MICHELLE M FLEMING
Title or Position: CHIEF OPERATING OFFICER
Credential: RN
Phone: 218-749-9410