Healthcare Provider Details

I. General information

NPI: 1366422248
Provider Name (Legal Business Name): SANDCREEK ECHO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 E 25TH ST
IDAHO FALLS ID
83404-6490
US

IV. Provider business mailing address

2050 E 25TH ST
IDAHO FALLS ID
83404-6490
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-2561
  • Fax: 208-529-2568
Mailing address:
  • Phone: 208-529-2561
  • Fax: 208-529-2568

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: KIMBERLY CARPENTER
Title or Position: PRESIDENT
Credential: RDCS,RVT
Phone: 208-529-2561