Healthcare Provider Details

I. General information

NPI: 1003851841
Provider Name (Legal Business Name): CENTRAL DAKOTA RADIOLOGISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

IV. Provider business mailing address

810 E ROSSER AVE STE 201
BISMARCK ND
58501-4463
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-7000
  • Fax:
Mailing address:
  • Phone: 866-607-5479
  • Fax: 920-739-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW STONE
Title or Position: SECRETARY/TREASURER
Credential: M.D.
Phone: 701-530-8575