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NPI Code Detail

MEDICARE: PROACTIVE MRI LLC

MEDICARE: PROACTIVE MRI LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RM1200XMagnetic Resonance Imaging (MRI) Internal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11215187737OTHERCONPI
21174016331OTHERNPI

General Provider Information

NPI Number : 1104397413
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROACTIVE MRI LLC
Provider Business Mailing Address
First Line : 329 E PLATTE AVE STE C
Second Line :
City : FORT MORGAN
State : CO
Zip : 80701-3172
Country : US
Telephone Number : 970-415-0855
Fax Number : 720-247-9072
Provider Business Practice Location Address
First Line : 329 E PLATTE AVE STE C
Second Line :
City : FORT MORGAN
State : CO
Zip : 80701-3172
Country : US
Telephone Number : 970-415-0855
Fax Number : 720-247-9072
Authorized Official
Title or Position : OWNER
Name : LEIF STEPHENS
Credential :
Telephone Number : 970-441-1117
Provider Enumeration Date : 12/12/2018
Last Update Date : 02/23/2024

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