Provider Demographics
NPI:1861800286
Name:3D MAMMOGRAPHY OF SOUTHWEST MONTANA, INC.
Entity type:Organization
Organization Name:3D MAMMOGRAPHY OF SOUTHWEST MONTANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RULE
Authorized Official - Suffix:
Authorized Official - Credentials:EA
Authorized Official - Phone:406-560-3266
Mailing Address - Street 1:800 W PLATINUM ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2200
Mailing Address - Country:US
Mailing Address - Phone:406-299-3302
Mailing Address - Fax:406-299-3304
Practice Address - Street 1:800 W PLATINUM ST
Practice Address - Street 2:UNIT D
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2200
Practice Address - Country:US
Practice Address - Phone:406-299-3302
Practice Address - Fax:406-299-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2085RP2020XMedicaid