Healthcare Provider Details

I. General information

NPI: 1619054921
Provider Name (Legal Business Name): KERMIT RAGAIN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 DILWORTH ST
GLENDIVE MT
59330-2053
US

IV. Provider business mailing address

107 DILWORTH ST
GLENDIVE MT
59330-2053
US

V. Phone/Fax

Practice location:
  • Phone: 406-345-8408
  • Fax: 406-345-3358
Mailing address:
  • Phone: 406-345-8408
  • Fax: 406-345-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number7438
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number7438
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number7438
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number7438
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7438
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number7438
License Number StateMT
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number7438
License Number StateMT

VIII. Authorized Official

Name: KERMIT RAGAIN
Title or Position: OWNER
Credential: M.D.
Phone: 406-345-8408