Provider Demographics
NPI:1871533802
Name:NORTH CENTRAL CARDIOVASCULAR DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:NORTH CENTRAL CARDIOVASCULAR DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-863-6175
Mailing Address - Street 1:920 E 28TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1139
Mailing Address - Country:US
Mailing Address - Phone:612-863-3900
Mailing Address - Fax:612-863-8887
Practice Address - Street 1:2024 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4529
Practice Address - Country:US
Practice Address - Phone:218-855-5280
Practice Address - Fax:218-855-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center