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General NPI Number Information
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NPI Number | 1285965079
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Entity Type | Organization
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Legal Business Name | PJ NOSS LLC
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 1200 E 25TH ST
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City | HIBBING
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State | MN
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Zip | 55746-3897
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Country | US
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Telephone | 218-312-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 1346 W ARROWHEAD RD # 175
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City | DULUTH
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State | MN
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Zip | 55811-2218
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Country | US
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Telephone | 218-310-8050
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHYLLIS NOSS
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Credential | M.D.
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Telephone | 218-312-3005
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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 | 44231
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License Number State | MN
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