Healthcare Provider Details

I. General information

NPI: 1497704860
Provider Name (Legal Business Name): DEACONESS INTERCITY IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HIGHLAND BLVD SUITE 4100
BOZEMAN MT
59715-6902
US

IV. Provider business mailing address

1648 ELLIS ST STE 201
BOZEMAN MT
59715-8811
US

V. Phone/Fax

Practice location:
  • Phone: 406-556-5200
  • Fax: 406-556-5205
Mailing address:
  • Phone: 406-587-8631
  • Fax: 406-587-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number7873
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDEE DESLAURIERS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 406-587-8631