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General NPI Number Information
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NPI Number | 1053311399
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Entity Type | Organization
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Legal Business Name | WEST IMAGING, LLC
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 3366 OAKDALE AVE N STE 401
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2986
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Country | US
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Telephone | 763-559-2171
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Fax | 763-398-6601
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Provider Business Mailing Address
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Address Line | 2955 XENIUM LN N SUITE 40
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City | PLYMOUTH
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State | MN
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Zip | 55441-2666
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Country | US
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Telephone | 763-559-2171
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Fax | 763-398-8701
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Authorized Official
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Title or Position | CREDENTIALING
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Name | KRISTEN CARLSON
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Credential |
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Telephone | 763-559-2171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 37855
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 37855
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License Number State | MN
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