OrganizationProactive Imaging Llc(<Unavail>)RadiologyAllopathic & Osteopathic PhysiciansPractice Address4000 W 76th St, Ste 100, Edina, MN 55435-5104(952) 853-7226PECOS EnrollmentBased on the most recent information from CMS, provider Proactive Imaging Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1619970910Provider TypeOrganizationFull NameProactive Imaging LlcOther Name<Unavail>SubpartNoEnumeration Date5/31/2005Last Updated10/2/2008Contact InformationPractice LocationPractice Address4000 W 76th St, Ste 100, Edina, MN 55435-5104Phone(952) 853-7226Fax(952) 831-7555Mailing LocationMailing Address4000 W 76th St, Ste 100, Edina, MN 55435-5104Phone(952) 853-7226Fax(952) 831-7555Authorized OfficialNameSoto, Angel L (President)Phone(954) 559-2421Provider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicense540MinnesotaProvider IdentifiersIDDescriptionIssuerID22030077DescriptionOtherIssuerOFFICE OF WORK COMP.MinnesotaIDP00053758DescriptionOtherIssuerMEDICARE RAILROADMinnesota