Provider Demographics
NPI:1518908938
Name:BOZEMAN MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:BOZEMAN MEDICAL IMAGING, LLC
Other - Org Name:ADVANCED 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 1:1099 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0711
Mailing Address - Country:US
Mailing Address - Phone:406-254-0005
Mailing Address - Fax:406-254-1325
Practice Address - Street 1:1099 N 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0711
Practice Address - Country:US
Practice Address - Phone:406-254-0005
Practice Address - Fax:406-254-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0760053Medicaid
P00005542OtherRAILROAD MEDICARE