Provider Demographics
NPI:1760708382
Name:GREAT DIVIDE RADIOLOGY, PLLP
Entity Type:Organization
Organization Name:GREAT DIVIDE RADIOLOGY, PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCSWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-459-4060
Mailing Address - Street 1:PO BOX 7777
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-7777
Mailing Address - Country:US
Mailing Address - Phone:406-459-4060
Mailing Address - Fax:406-449-0880
Practice Address - Street 1:2475 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4928
Practice Address - Country:US
Practice Address - Phone:406-459-4060
Practice Address - Fax:406-449-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty