Healthcare Provider Details

I. General information

NPI: 1386713832
Provider Name (Legal Business Name): NORTHWEST IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

PO BOX 9110
KALISPELL MT
59904-2110
US

V. Phone/Fax

Practice location:
  • Phone: 406-751-7519
  • Fax: 406-751-7529
Mailing address:
  • Phone: 406-751-7519
  • Fax: 406-751-7529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TYLER W WEBER
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 406-751-7519