Organization
SPINE IMAGING MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDUARDO BULLON (CHIEF EXECUTIVE OFFICER)
(651) 647-0000
Entity
Organization
Contact information
Practice address
393 NORTH DUNLAP STREET, SUITE LL40, ST PAUL, MN 55104
(651) 647-0000
(651) 645-9000
Mailing address
393 NORTH DUNLAP STREET, SUITE LL40, ST PAUL, MN 55104
(651) 647-0000
(651) 645-9000
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83M805P
BLUE CROSS
MN
01
—
99121
HEALTH PARTNERS
MN
Enumeration date
05/21/2007
Last updated
08/22/2020
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