Dennis W Runck Jr., MD
Individual provider Active NPI Diagnostic Radiology Physician · Big Sky, MT
NPI 1285613091 · NPPES record last updated Sep 12, 2014
Key facts
- NPI
- 1285613091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 10839 (MT)
- Practice address
- 85 Amber Lilly Drive
Big Sky, MT 59716-1715 - Phone
- (651) 292-2000
- Fax
- (651) 292-2178
- NPI assigned
- Jan 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10010 | ND | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Livingston Healthcare | Past | Accepting new patients | |
| Midwest Radiology, PA | Diagnostic Radiology | Past | Accepting new patients |
| Allen Memorial Hospital Corporation | Diagnostic Radiology | Past | Accepting new patients |
| Midwest Radiology Outpatient Imaging, LLC | Diagnostic Radiology | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 31004 | MN | |
| Diagnostic Radiology Physician | 2085R0202X | 10839 | MT | Yes |
| Diagnostic Radiology Physician | 2085R0202X | 10010 | ND |
Addresses
Primary practice location
85 Amber Lilly Drive
Big Sky, MT 59716-1715
Mailing address
PO Box 161715
Big Sky, MT 59716-1715
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 259305000 | Medicaid | MN |
Other providers in Big Sky, MT
- Erica Perlman - Hensen
- Anne Pytka
- Jacqueline Anne Rager
- Erika L Rauk
- Wendy R Rogers
- Jeff Saad
- Raelene Ursula Schott
- Kevin Curtis Sullivan
- Daniel Tanbakuchi
- Elizabeth M Tapen
All providers in Big Sky, MT · Diagnostic Radiology Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.