Provider Demographics
NPI:1144489824
Name:NORTH STAR MEDICAL IMAGING PLLC
Entity type:Organization
Organization Name:NORTH STAR MEDICAL IMAGING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DESROSIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-428-7212
Mailing Address - Street 1:125 N 18TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3902
Mailing Address - Country:US
Mailing Address - Phone:360-424-6161
Mailing Address - Fax:360-848-1167
Practice Address - Street 1:125 N 18TH ST STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3902
Practice Address - Country:US
Practice Address - Phone:360-424-6161
Practice Address - Fax:360-848-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty