=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023039278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY MRI SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 12/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1252 WASHINGTON AVE
-----------------------------------------------------
City | DETROIT LAKES
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56501-3928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-847-6316
-----------------------------------------------------
Fax | 218-847-6303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3223 32ND AVENUE S SUITE 201
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58103-6278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-297-0305
-----------------------------------------------------
Fax | 701-235-9660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL J HOFER SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 701-297-0305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------