MEDICARE: RAI KEYSTONE IMAGING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1609392349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAI KEYSTONE IMAGING SERVICES, LLC

Provider Business Mailing Address
First Line	:	5775 WAYZATA BLVD STE 400
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1271
Country	:	US
Telephone Number	:	952-525-6338
Fax Number	:	952-905-5697

Provider Business Practice Location Address
First Line	:	5775 WAYZATA BLVD STE 400
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1271
Country	:	US
Telephone Number	:	952-525-6338
Fax Number	:	952-905-5697

Authorized Official
Title or Position	:	SPECIAL ASSISTANT SECRETARY
Name	:	SUSAN C. HOLMAN
Credential	:
Telephone Number	:	952-525-6338

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	07/21/2022

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