Healthcare Provider Details

I. General information

NPI: 1265425029
Provider Name (Legal Business Name): NORTH IDAHO MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W IRONWOOD DR
COEUR D ALENE ID
83814-2673
US

IV. Provider business mailing address

PO BOX 3103
COEUR D ALENE ID
83816-2525
US

V. Phone/Fax

Practice location:
  • Phone: 208-666-3119
  • Fax: 208-666-3963
Mailing address:
  • Phone: 208-666-3119
  • Fax: 208-666-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS J LEGEL
Title or Position: CFO
Credential:
Phone: 208-666-2000