Provider Demographics
NPI:1417993221
Name:BOZEMAN MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:BOZEMAN MEDICAL IMAGING, LLC
Other - Org Name:BOZEMAN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:406-582-0005
Mailing Address - Street 1:2150 ANALYSIS DR
Mailing Address - Street 2:ADVANCED TECHNOLOGY PARK
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6814
Mailing Address - Country:US
Mailing Address - Phone:406-582-0005
Mailing Address - Fax:406-582-0830
Practice Address - Street 1:2150 ANALYSIS DR
Practice Address - Street 2:ADVANCED TECHNOLOGY PARK
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6814
Practice Address - Country:US
Practice Address - Phone:406-582-0005
Practice Address - Fax:406-582-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT06-000024582471M1202X, 261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0760053Medicaid