Provider Demographics
NPI:1962584508
Name:BILLINGS MRI CENTER, LLC.
Entity type:Organization
Organization Name:BILLINGS MRI CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-0455
Mailing Address - Street 1:1041 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0700
Mailing Address - Country:US
Mailing Address - Phone:406-255-6530
Mailing Address - Fax:406-247-1087
Practice Address - Street 1:1041 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0700
Practice Address - Country:US
Practice Address - Phone:406-255-6530
Practice Address - Fax:406-247-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0078286Medicaid
MT0078299Medicaid
MT0078299Medicaid