Provider Demographics
NPI:1902871544
Name:NORTHERN ROCKIES RADIATION ONCOLOGY CENTER LLC
Entity Type:Organization
Organization Name:NORTHERN ROCKIES RADIATION ONCOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:BROSWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-0455
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103
Mailing Address - Country:US
Mailing Address - Phone:406-248-2212
Mailing Address - Fax:406-237-0472
Practice Address - Street 1:1041 N 29TH
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-248-2212
Practice Address - Fax:406-237-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10275261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0066729Medicaid