Healthcare Provider Details

I. General information

NPI: 1740519933
Provider Name (Legal Business Name): MRI SCHOOL OF MINNESOTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6053 HUDSON RD STE 265
WOODBURY MN
55125-1000
US

IV. Provider business mailing address

6053 HUDSON RD STE 265
WOODBURY MN
55125-1000
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-0674
  • Fax: 651-702-2502
Mailing address:
  • Phone: 651-702-0674
  • Fax: 651-702-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number2742928-2
License Number StateMN

VIII. Authorized Official

Name: QUINCY CHERMAN
Title or Position: VP OF OPERATIONS
Credential:
Phone: 651-702-0674