Provider Demographics
NPI:1356397343
Name:MONTANA INTERVENTIONAL AND DIAGNOSTIC RADIOLOGY SPECIALISTS, PLLC
Entity type:Organization
Organization Name:MONTANA INTERVENTIONAL AND DIAGNOSTIC RADIOLOGY SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-449-3211
Mailing Address - Street 1:25 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4949
Mailing Address - Country:US
Mailing Address - Phone:406-449-3211
Mailing Address - Fax:406-442-4863
Practice Address - Street 1:25 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4949
Practice Address - Country:US
Practice Address - Phone:406-449-3211
Practice Address - Fax:406-442-4863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000083953Medicare PIN