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General NPI Number Information
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NPI Number | 1750788865
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Entity Type | Organization
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Legal Business Name | NORTHSTAR RADIOLOGY - CALIFORNIA
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 1800 SPRING RIDGE DR
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City | SUSANVILLE
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State | CA
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Zip | 96130-6100
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Country | US
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Telephone | 608-788-8103
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Fax | 608-788-8799
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Provider Business Mailing Address
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Address Line | 2031 32ND ST S
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City | LA CROSSE
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State | WI
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Zip | 54601-7099
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Country | US
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Telephone | 608-788-8103
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Fax | 608-788-8799
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT LECKIE
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Credential | MD
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Telephone | 775-853-8422
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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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