1861800286 NPI number — 3D MAMMOGRAPHY OF SOUTHWEST MONTANA, INC.

Table of content: (NPI 1861800286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861800286 NPI number — 3D MAMMOGRAPHY OF SOUTHWEST MONTANA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
3D MAMMOGRAPHY OF SOUTHWEST MONTANA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861800286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W PLATINUM ST
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
BUTTE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59701-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-299-3302
Provider Business Mailing Address Fax Number:
406-299-3304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W PLATINUM ST
Provider Second Line Business Practice Location Address:
UNIT D
Provider Business Practice Location Address City Name:
BUTTE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59701-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-299-3302
Provider Business Practice Location Address Fax Number:
406-299-3304
Provider Enumeration Date:
07/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RULE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-560-3266

Provider Taxonomy Codes

  • Taxonomy code: 261QR0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2085RP2020X , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com