Provider Demographics
NPI:1417028648
Name:MEDICAL IMAGING CONNECTIONS
Entity Type:Organization
Organization Name:MEDICAL IMAGING CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KELLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-323-7226
Mailing Address - Street 1:1220 2ND ST W
Mailing Address - Street 2:P.O. BOX 931
Mailing Address - City:ROUNDUP
Mailing Address - State:MT
Mailing Address - Zip Code:59072-1836
Mailing Address - Country:US
Mailing Address - Phone:406-323-7226
Mailing Address - Fax:206-339-7486
Practice Address - Street 1:1220 2ND ST W
Practice Address - Street 2:
Practice Address - City:ROUNDUP
Practice Address - State:MT
Practice Address - Zip Code:59072-1836
Practice Address - Country:US
Practice Address - Phone:406-323-7226
Practice Address - Fax:206-339-7486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Not Answered261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT094605OtherBCBS OF MONTANA
MT760104Medicaid