Healthcare Provider Details

I. General information

NPI: 1871797761
Provider Name (Legal Business Name): FOREST IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CLIFF MANOR LN
GALLATIN GATEWAY MT
59730-9746
US

IV. Provider business mailing address

5288 EASTGATE MALL SUITE A
SAN DIEGO CA
92121-2835
US

V. Phone/Fax

Practice location:
  • Phone: 619-218-6460
  • Fax: 858-866-0760
Mailing address:
  • Phone: 858-622-0792
  • Fax: 858-866-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROY ANTHONY BROWN
Title or Position: OWNER
Credential: RT
Phone: 619-218-6460