Organization
PJ NOSS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS NOSS M.D. (OWNER)
(218) 312-3005
Entity
Organization
Contact information
Practice address
1200 E 25TH ST, HIBBING, MN 55746-3897
(218) 312-3005
Mailing address
1346 W ARROWHEAD RD # 175, DULUTH, MN 55811-2218
(218) 310-8050
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
44231
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
087K5NO
BLUE CROSS BLUE SHIELD
MN
01
—
1602543
MEDICA
MN
01
—
164104
UCARE
MN
05
—
372124800
—
MN
01
—
DQ0614
RAIL ROAD MEDICARE
MN
Enumeration date
01/19/2010
Last updated
05/04/2010
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