Provider Demographics
NPI:1003906413
Name:MRI CENTER LLC
Entity Type:Organization
Organization Name:MRI CENTER LLC
Other - Org Name:MONTANA REGIONAL IMAGING CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:RT R MRI QM CT
Authorized Official - Phone:406-449-3750
Mailing Address - Street 1:3510 PTARMIGAN LN
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0553
Mailing Address - Country:US
Mailing Address - Phone:406-449-3750
Mailing Address - Fax:
Practice Address - Street 1:3510 PTARMIGAN LN
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0553
Practice Address - Country:US
Practice Address - Phone:406-449-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10192471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0760123Medicaid