Healthcare Provider Details

I. General information

NPI: 1649556838
Provider Name (Legal Business Name): BLACK ROCK ADVANCED MEDICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 4J CT UNIT C
GILLETTE WY
82716-4130
US

IV. Provider business mailing address

620 4 J CT UNIT D
GILLETTE WY
82716-4130
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-8228
  • Fax: 307-682-8266
Mailing address:
  • Phone: 307-682-8228
  • Fax: 307-682-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK GREGORY MURPHY
Title or Position: PRESIDENT
Credential: MD
Phone: 307-358-6200