Healthcare Provider Details

I. General information

NPI: 1780112862
Provider Name (Legal Business Name): COPPER CITY RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CLARK ST
BUTTE MT
59701-2328
US

IV. Provider business mailing address

PO BOX 1160
HELENA MT
59624-1160
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-2658
  • Fax: 406-723-2624
Mailing address:
  • Phone: 406-723-2658
  • Fax: 406-723-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10582
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HASSAN MASSOUH
Title or Position: OWNER
Credential: MD
Phone: 406-461-2953