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General NPI Number Information
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NPI Number | 1487787016
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Entity Type | Organization
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Legal Business Name | NORTHSTAR RADIOLOGY CORPORATION PA
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 36 NATHAN LANE N
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City | PLYMOUTH
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State | MN
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Zip | 55441
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Country | US
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Telephone | 612-437-1191
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 396
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City | HOPKINS
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State | MN
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Zip | 55343-0396
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Country | US
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Telephone | 612-437-1191
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM J FORD III
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Credential | MD
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Telephone | 612-437-1191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 27851
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License Number State | MN
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