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NPI Code Detail

MEDICARE: INTERCITY RADIOLOGY, PC

MEDICARE: INTERCITY RADIOLOGY, PC
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
1174400000XSpecialist

General Provider Information

NPI Number : 1356390736
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERCITY RADIOLOGY, PC
Provider Business Mailing Address
First Line : 1648 ELLIS ST STE 201
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-8811
Country : US
Telephone Number : 406-587-8631
Fax Number : 406-587-1343
Provider Business Practice Location Address
First Line : 1648 ELLIS ST STE 201
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-8811
Country : US
Telephone Number : 406-587-8631
Fax Number : 406-587-1343
Authorized Official
Title or Position : CREDENTIALING MANGER
Name : JESSICALEE FANDRICH
Credential :
Telephone Number : 406-587-8631
Provider Enumeration Date : 05/10/2006
Last Update Date : 09/04/2020

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Directions to “INTERCITY RADIOLOGY, PC ” Practice Location

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