Provider Demographics
NPI:1144331141
Name:INSTITUTE OF DIAGNOSTIC IMAGING, LLC
Entity type:Organization
Organization Name:INSTITUTE OF DIAGNOSTIC IMAGING, 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 1:2829 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6050
Mailing Address - Country:US
Mailing Address - Phone:701-297-0305
Mailing Address - Fax:701-235-4847
Practice Address - Street 1:11819 MIRACLE HILLS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4428
Practice Address - Country:US
Practice Address - Phone:402-898-3630
Practice Address - Fax:402-898-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE04128OtherBCBS
NE1015837OtherGREAT WEST
NE=========OtherMIDLANDS CHOICE
NE=========-00Medicaid
=========001OtherTRICARE
NE04128OtherBCBS