Provider Demographics
NPI:1578674586
Name:INSTITUTE OF DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:INSTITUTE OF DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOFER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:701-297-0305
Mailing Address - Street 1:3223 32ND AVENUE S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6278
Mailing Address - Country:US
Mailing Address - Phone:701-297-0305
Mailing Address - Fax:701-235-9660
Practice Address - Street 1:2829 SOUTH UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6029
Practice Address - Country:US
Practice Address - Phone:701-234-0112
Practice Address - Fax:701-235-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN34Q05INOtherBCBS
1602915OtherMEDICA
933411015837OtherPREFERRED ONE
SD7290170Medicaid
ND25965OtherBCBS
470000565OtherRAILROAD MEDICARE
MN627327100Medicaid
123669600OtherFEDERAL WORK COMP
ND10342Medicaid
2109663OtherFIRST HEALTH
300087709OtherUNITED HEALTHCARE
470000565OtherRAILROAD MEDICARE
NDN70944Medicare PIN