Healthcare Provider Details

I. General information

NPI: 1811646961
Provider Name (Legal Business Name): MONTANA IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 12/14/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S RESERVE ST
MISSOULA MT
59801-4756
US

IV. Provider business mailing address

1510 S RESERVE ST
MISSOULA MT
59801-4756
US

V. Phone/Fax

Practice location:
  • Phone: 406-540-4117
  • Fax:
Mailing address:
  • Phone: 406-540-4117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY MCCUE
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 406-540-4117