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General NPI Number Information
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NPI Number | 1417935321
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Entity Type | Organization
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Legal Business Name | REGIONAL DIAGNOSTIC RADIOLOGY
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 1990 CONNECTICUT AVE S
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City | SARTELL
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State | MN
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Zip | 56377-2554
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Country | US
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Telephone | 320-257-5595
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Fax | 320-257-5596
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Provider Business Mailing Address
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Address Line | PO BOX 7366
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City | SAINT CLOUD
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State | MN
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Zip | 56302-7366
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Country | US
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Telephone | 320-257-5595
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Fax | 320-257-5596
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MARY E HONDL
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Credential |
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Telephone | 320-257-7794
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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 |
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License Number State |
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