MEDICARE: COMMUNITY MRI SERVICES, 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
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1598033755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MRI SERVICES, LLC

Provider Business Mailing Address
First Line	:	3223 32ND AVE S
Second Line	:	SUITE 201
City	:	FARGO
State	:	ND
Zip	:	58103-6297
Country	:	US
Telephone Number	:	701-297-0305
Fax Number	:	701-235-9660

Provider Business Practice Location Address
First Line	:	1739 SPRING CREEK LANE
Second Line	:	SUITE 400
City	:	BILLINGS
State	:	MT
Zip	:	59102-6756
Country	:	US
Telephone Number	:	406-325-5030
Fax Number	:	406-325-5031

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL J HOFER SR.
Credential	:
Telephone Number	:	701-297-0305

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	02/15/2012

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