Provider Demographics
NPI:1962791541
Name:MED CITY X-RAY
Entity type:Organization
Organization Name:MED CITY X-RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-254-9464
Mailing Address - Street 1:5220 PALMER LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3871
Mailing Address - Country:US
Mailing Address - Phone:507-254-9464
Mailing Address - Fax:
Practice Address - Street 1:5220 PALMER LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3871
Practice Address - Country:US
Practice Address - Phone:507-254-9464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMNXO-1218261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile