Provider Demographics
NPI:1366423618
Name:PRAIRIE IMAGING, PC
Entity type:Organization
Organization Name:PRAIRIE IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-483-4546
Mailing Address - Street 1:112 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5136
Mailing Address - Country:US
Mailing Address - Phone:701-486-4546
Mailing Address - Fax:701-483-4545
Practice Address - Street 1:112 3RD ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5136
Practice Address - Country:US
Practice Address - Phone:701-486-4546
Practice Address - Fax:701-483-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND98742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12750Medicaid
ND13281Medicaid
NDP00156697Medicare PIN
ND70321Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NDCP8477Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #
ND24998Medicare PIN
ND12750Medicaid