Provider Demographics
NPI:1477503209
Name:DMS IMAGING INC
Entity Type:Organization
Organization Name:DMS IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-297-3097
Mailing Address - Street 1:2101 UNIVERSITY DR N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1816
Mailing Address - Country:US
Mailing Address - Phone:701-237-9073
Mailing Address - Fax:701-297-3077
Practice Address - Street 1:2101 UNIVERSITY DR N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1816
Practice Address - Country:US
Practice Address - Phone:701-237-9073
Practice Address - Fax:701-297-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5580430Medicaid
SD5580430Medicaid
SD40826Medicare ID - Type UnspecifiedIDTF