Healthcare Provider Details

I. General information

NPI: 1437827482
Provider Name (Legal Business Name): FOUNTAIN POINT IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 W NORFOLK AVE STE R
NORFOLK NE
68701-4405
US

IV. Provider business mailing address

1104 W 8TH ST
YANKTON SD
57078-3306
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-2349
  • Fax: 402-379-2437
Mailing address:
  • Phone: 605-665-7841
  • Fax: 605-665-8337

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: BECKY MCMANUS
Title or Position: CEO
Credential:
Phone: 605-665-6919