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General NPI Number Information
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NPI Number | 1144828260
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Entity Type | Organization
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Legal Business Name | GLACIER ULTRASOUND SERVICE LLC
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 200 ASPEN LOOP
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City | KALISPELL
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State | MT
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Zip | 59901-3312
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Country | US
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Telephone | 406-471-6636
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Fax |
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Provider Business Mailing Address
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Address Line | 200 ASPEN LOOP
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City | KALISPELL
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State | MT
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Zip | 59901-3312
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Country | US
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Telephone | 406-471-6636
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLAY NAOMI
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Credential | RDMS
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Telephone | 406-471-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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