Organization
CENTRAL MONTANA IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MARK POULSEN (ADMINISTRATOR)
(406) 799-5880
Entity
Organization
Contact information
Practice address
1417 9TH ST S, SUITE 102, GREAT FALLS, MT 59405-4509
(406) 216-0040
(406) 216-0041
Mailing address
1417 9TH ST S, SUITE 102, GREAT FALLS, MT 59405-4509
(406) 216-0040
(406) 216-0041
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
9758
MT
261QR0200X
Radiology Clinic/Center
Primary
9758
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0760058
—
MT
Enumeration date
08/09/2005
Last updated
08/17/2011
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