#21 Midwest Diagnostic Management LLC

Huge growth wasn't exactly in Kevin Tremblay's initial business plan. When he founded Midwest Diagnostic Management LLC (MDM) in June 2000, he says, "we had dreams of one day getting to 20 employees and just having a nice lifestyle." Today, he has 89 employees.

At only four months, the business was recognized by patients, providers and insurance companies, and Tremblay realized how vital his service was. He networks independently owned medical diagnostic radiology centers (to provide tests such as MRIs and CT scans) and streamlines the PPO referral process for doctors, patients and insurers. Early on, the company built a reputation for good customer service and received so many inquiries that Tremblay, 38, had to come up with a plan. "We said, 'We've got a couple of choices: We either dig in and go after it or choose not to.'"

Tremblay and his crew chose to go forward at full steam. Growing from $1.6 million in sales during MDM's first fiscal year to a projected $34 million in 2004, Tremblay used careful hiring practices to staff for the massive growth. "We kept adding wonderfully talented people, and we spent extra time making sure we were recruiting and maybe paying a little bit more for the right people," he says. Tremblay contracts with the diagnostic companies with equally meticulous attention. "If it takes a couple [extra] days before you fill that role, you [still] need to spend the time and make sure you know who you're working with."

Good hiring practices are even more important now that Tremblay juggles three businesses. He started Advanced Ancillary Services LLC (AAS) in June 2002 and Diagnostic PET Network LLC (DPN) in March 2003 to round out his client offerings. AAS outsources cost-saving services for employers and insurance companies, while DPN has created a network of PET diagnostic centers (for early cancer detection).

Looking to the future, Tremblay is striving for sales of $50 million for all three companies. He likens his entrepreneurial journey to a child learning how to crawl, then walk, then run. "We're watching all those details-we're watching our vendors, our bottom line, our sales growth, and we're in a nice run right now."