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General NPI Number Information
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NPI Number | 1053338780
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC RADIOLOGIC IMAGING PA
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1607 N MCMILLAN ST STE 1
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City | WORTHINGTON
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State | MN
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Zip | 56187
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Country | US
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Telephone | 507-372-2120
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Fax | 507-372-4585
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Provider Business Mailing Address
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Address Line | PO BOX 338
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City | WORTHINGTON
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State | MN
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Zip | 56187
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Country | US
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Telephone | 507-372-2120
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Fax | 507-372-4585
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LORI J SPARTZ
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Credential |
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Telephone | 507-372-2120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 545
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License Number State | MN
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