Healthcare Provider Details

I. General information

NPI: 1750159398
Provider Name (Legal Business Name): BISMARCK RADIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

IV. Provider business mailing address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 701-333-8354
  • Fax:
Mailing address:
  • Phone: 701-333-8354
  • Fax:

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: LUKE B ROLLER
Title or Position: MD
Credential: MD
Phone: 701-530-7000