Provider Demographics
NPI:1679518260
Name:NORTHLAND RADIOLOGY, INC.
Entity type:Organization
Organization Name:NORTHLAND RADIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MO
Authorized Official - Phone:816-691-5201
Mailing Address - Street 1:PO BOX 30075
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-1175
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:2800 CLAY EDWARDS DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3220
Practice Address - Country:US
Practice Address - Phone:816-691-5201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200671520AMedicaid
MO503618100Medicaid
MOCP5297OtherRR MEDICARE
MO5503014OtherBCBSKC
MOMO20204BOtherBEECHSTREET/MULTIPLAN
MO045747OtherCMFHP
MO0190000Medicare PIN