MEDICARE: NEW FRONTIER IMAGING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1417257114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW FRONTIER IMAGING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2148
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82902-2148
Country	:	US
Telephone Number	:	913-642-4900
Fax Number	:	913-381-0979

Provider Business Practice Location Address
First Line	:	2620 COMMERCIAL WAY
Second Line	:	STE. 10
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4755
Country	:	US
Telephone Number	:	307-371-0577
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARIA STRADLEY
Credential	:
Telephone Number	:	307-371-0577

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	04/01/2014

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