Provider Demographics
NPI:1689885717
Name:SNIDER, BETTEJO (RT)
Entity Type:Individual
Prefix:
First Name:BETTEJO
Middle Name:
Last Name:SNIDER
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13190 HOGELAND RD
Mailing Address - Street 2:
Mailing Address - City:HOGELAND
Mailing Address - State:MT
Mailing Address - Zip Code:59529-9609
Mailing Address - Country:US
Mailing Address - Phone:406-379-2684
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 67
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9705
Practice Address - Country:US
Practice Address - Phone:406-353-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1397247100000X, 2471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1397OtherLICENSE