Healthcare Provider Details

I. General information

NPI: 1710088448
Provider Name (Legal Business Name): NORTH VALLEY DEXA SCAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BAKER AVE
WHITEFISH MT
59937-2901
US

IV. Provider business mailing address

1111 BAKER AVE
WHITEFISH MT
59937-2901
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-2515
  • Fax: 406-862-4229
Mailing address:
  • Phone: 406-862-2515
  • Fax: 406-862-4229

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: MS. PATTI L REED
Title or Position: MANAGER
Credential:
Phone: 406-862-2515