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Organization
SUBURBAN RADIOLOGIC CONSULTANTS, LTD.
Active
Organization
SUBURBAN RADIOLOGIC CONSULTANTS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT STAROSTA (CEO)
(952) 837-9754
Entity
Organization
Contact information
Practice address
2355 HWY 36 W., STE. 100, ROSEVILLE, MN 55113-5511
(651) 292-2000
Mailing address
2355 HWY 36 W., STE. 100, ROSEVILLE, MN 55113
(651) 292-2000
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
261
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5077087-00
—
MN
01
—
CT0958
RAILROAD MEDICARE
—
Enumeration date
05/09/2006
Last updated
06/30/2020
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