Victor NG

Individual provider Active NPI Medical Technologist · Box Elder, MT

NPI 1053678367 · NPPES record last updated Apr 12, 2012

Key facts

NPI
1053678367
Entity type
Individual (NPI type 1)
Primary specialty
Medical Technologist 246QM0706X
License
1561 (MT)
Practice address
535 Clinic Rd E
Box Elder, MT 59521-8826
Phone
(406) 395-4486
Fax
(406) 395-5315
NPI assigned
Apr 12, 2012
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1561MTMDDentist
RTS-LPH-LIC-3126MTMDRadiologic Technologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Technologist 246QM0706X 1561 MT Yes
Radiologic Technologist 247100000X RTS-LPH-LIC-3126 MT

Addresses

Primary practice location

535 Clinic Rd E
Box Elder, MT 59521-8826

Mailing address

535 Clinic Rd E
Box Elder, MT 59521-8826
Phone (406) 395-4486

Other providers in Box Elder, MT

All providers in Box Elder, MT · Medical Technologist in Montana

Sources for this page

Verify at the official NPI Registry.