Provider Demographics
NPI:1013021500
Name:FRANCES MAHON DEACONESS HOSPITAL
Entity Type:Organization
Organization Name:FRANCES MAHON DEACONESS HOSPITAL
Other - Org Name:DEACONESS RADIOLOGY SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-228-3615
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-0307
Mailing Address - Country:US
Mailing Address - Phone:406-228-3500
Mailing Address - Fax:406-228-3533
Practice Address - Street 1:621 3RD ST S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2604
Practice Address - Country:US
Practice Address - Phone:406-228-3500
Practice Address - Fax:406-228-3533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCES MAHON DEACONESS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-19
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT092150OtherBC/BS RADIOLOGY
MT0351949Medicaid
MT0351949Medicaid
MTCD3143Medicare PIN
MTM000009907Medicare PIN