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General NPI Number Information
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NPI Number | 1578674586
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF DIAGNOSTIC IMAGING, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 2829 SOUTH UNIVERSITY DRIVE SUITE 102
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City | FARGO
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State | ND
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Zip | 58103-6029
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Country | US
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Telephone | 701-234-0112
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Fax | 701-235-9660
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Provider Business Mailing Address
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Address Line | 3223 32ND AVENUE S SUITE 201
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City | FARGO
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State | ND
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Zip | 58103-6278
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Country | US
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Telephone | 701-297-0305
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Fax | 701-235-9660
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL J HOFER SR.
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Credential |
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Telephone | 701-297-0305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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