Healthcare Provider Details

I. General information

NPI: 1376536763
Provider Name (Legal Business Name): YELLOWSTONE RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SHERIDAN AVE
CODY WY
82414-3409
US

IV. Provider business mailing address

PO BOX 1829
COEUR D ALENE ID
83816-1829
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-9334
  • Fax: 208-664-2341
Mailing address:
  • Phone: 800-667-9334
  • Fax: 208-664-2341

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: DR. GREGORY H CROSS
Title or Position: DELEGATED OFFICIAL
Credential: MD
Phone: 307-578-2582