Provider Demographics
NPI:1932523768
Name:LIFE IMAGING, PA
Entity type:Organization
Organization Name:LIFE IMAGING, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GUTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-451-3311
Mailing Address - Street 1:485 ARUNDEL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1931
Mailing Address - Country:US
Mailing Address - Phone:651-451-3311
Mailing Address - Fax:651-451-3377
Practice Address - Street 1:2125 UPPER 55TH ST E
Practice Address - Street 2:SUITE 250
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1734
Practice Address - Country:US
Practice Address - Phone:651-451-3311
Practice Address - Fax:651-451-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)