Provider Demographics
NPI:1538254586
Name:INDEPENDENT RADIOLOGY SERVICES, LTD.
Entity type:Organization
Organization Name:INDEPENDENT RADIOLOGY SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-274-2459
Mailing Address - Street 1:PO BOX 2746
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-2746
Mailing Address - Country:US
Mailing Address - Phone:701-293-0522
Mailing Address - Fax:
Practice Address - Street 1:2829 UNIVERSITY DR S
Practice Address - Street 2:SITE 104
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6050
Practice Address - Country:US
Practice Address - Phone:701-293-0522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN49517GMOtherBC/BS
MN633313300Medicaid
ND16301Medicaid
MN633313300Medicaid