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General NPI Number Information
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NPI Number | 1780112862
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Entity Type | Organization
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Legal Business Name | COPPER CITY RADIOLOGY PC
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 400 S CLARK ST
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City | BUTTE
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State | MT
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Zip | 59701-2328
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Country | US
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Telephone | 406-723-2658
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Fax | 406-723-2624
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Provider Business Mailing Address
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Address Line | PO BOX 1160
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City | HELENA
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State | MT
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Zip | 59624-1160
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Country | US
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Telephone | 406-723-2658
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Fax | 406-723-2624
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Authorized Official
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Title or Position | OWNER
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Name | DR. HASSAN MASSOUH
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Credential | MD
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Telephone | 406-461-2953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 10582
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License Number State | MT
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