Provider Demographics
NPI:1588688980
Name:BITTERROOT IMAGING OPEN MRI, L.L.C
Entity type:Organization
Organization Name:BITTERROOT IMAGING OPEN MRI, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-329-2866
Mailing Address - Street 1:1103 WESTWOOD DR
Mailing Address - Street 2:P.O. BOX 1555
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-5315
Mailing Address - Country:US
Mailing Address - Phone:406-363-7439
Mailing Address - Fax:406-363-5221
Practice Address - Street 1:1103 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-5315
Practice Address - Country:US
Practice Address - Phone:406-363-7439
Practice Address - Fax:406-363-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000085604Medicare PIN