Provider Demographics
NPI:1023039278
Name:COMMUNITY MRI SERVICES, LLC
Entity type:Organization
Organization Name:COMMUNITY MRI SERVICES, 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 1:1252 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3928
Practice Address - Country:US
Practice Address - Phone:218-847-6316
Practice Address - Fax:218-847-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1026467OtherPREFERRED ONE
MN650069200Medicaid
MN269M3COOtherMINNESOTA BCBS
MN141965700OtherUS DEPT OF LABOR
MN1602881OtherMEDICA
MN470000045Medicare PIN