MEDICARE: RIVERS BEND 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1912776246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERS BEND IMAGING LLC

Provider Business Mailing Address
First Line	:	350 23RD AVE E STE 102
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-7401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 23RD AVE E STE 102
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-7401
Country	:	US
Telephone Number	:	701-356-7444
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN BROADWAY
Credential	:	MD
Telephone Number	:	701-356-7444

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	12/28/2023

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