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General NPI Number Information
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NPI Number | 1861811333
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Entity Type | Organization
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Legal Business Name | WOODBURY MRI, LLC
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 6053 HUDSON RD STE 140
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City | WOODBURY
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State | MN
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Zip | 55125-1022
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Country | US
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Telephone | 651-728-1867
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Fax |
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Provider Business Mailing Address
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Address Line | 6053 HUDSON RD STE 140
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City | WOODBURY
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State | MN
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Zip | 55125-1022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | QUINCY CHERMAN
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Credential |
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Telephone | 651-728-1867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | 3578719-2
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License Number State | MN
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