Healthcare Provider Details

I. General information

NPI: 1902871544
Provider Name (Legal Business Name): NORTHERN ROCKIES RADIATION ONCOLOGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N 29TH
BILLINGS MT
59101
US

IV. Provider business mailing address

PO BOX 369
BILLINGS MT
59103
US

V. Phone/Fax

Practice location:
  • Phone: 406-248-2212
  • Fax: 406-237-0472
Mailing address:
  • Phone: 406-248-2212
  • Fax: 406-237-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number10275
License Number StateMT

VIII. Authorized Official

Name: BRUCE I BROSWICK
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 406-237-0455