Healthcare Provider Details

I. General information

NPI: 1205274677
Provider Name (Legal Business Name): LEAH CAROLINE GODSEY RDCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S WOODRUFF AVE STE 12B
IDAHO FALLS ID
83404-6372
US

IV. Provider business mailing address

2001 S WOODRUFF AVE STE 12B
IDAHO FALLS ID
83404-6372
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-2498
  • Fax: 208-528-7971
Mailing address:
  • Phone: 208-529-2498
  • Fax: 208-528-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: