Provider Demographics
NPI:1306590310
Name:IDTS MEDICAL, INC.
Entity type:Organization
Organization Name:IDTS MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NOZZARELLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:612-295-0121
Mailing Address - Street 1:7545 VETERANS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-7500
Mailing Address - Country:US
Mailing Address - Phone:612-325-3600
Mailing Address - Fax:
Practice Address - Street 1:7545 VETERANS DR STE 200
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-7500
Practice Address - Country:US
Practice Address - Phone:612-295-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center