Provider Demographics
NPI:1194725044
Name:ARROWHEAD CONSULTATION SERVICE LTD
Entity type:Organization
Organization Name:ARROWHEAD CONSULTATION SERVICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-326-5424
Mailing Address - Street 1:415 SE 13TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4248
Mailing Address - Country:US
Mailing Address - Phone:218-326-5424
Mailing Address - Fax:218-327-4930
Practice Address - Street 1:415 SE 13TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4248
Practice Address - Country:US
Practice Address - Phone:218-326-5424
Practice Address - Fax:218-327-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08153Medicare ID - Type Unspecified