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General NPI Number Information
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NPI Number | 1376536763
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Entity Type | Organization
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Legal Business Name | YELLOWSTONE RADIOLOGY PC
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 707 SHERIDAN AVE
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City | CODY
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State | WY
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Zip | 82414-3409
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Country | US
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Telephone | 208-667-9334
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Fax | 208-664-2341
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Provider Business Mailing Address
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Address Line | PO BOX 1829
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City | COEUR D ALENE
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State | ID
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Zip | 83816-1829
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Country | US
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Telephone | 800-667-9334
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Fax | 208-664-2341
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | DR. GREGORY H CROSS
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Credential | MD
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Telephone | 307-578-2582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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