Healthcare Provider Details

I. General information

NPI: 1881649234
Provider Name (Legal Business Name): MRI MOBILE HOLDINGS LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 12TH AVENUE ROAD
NAMPA ID
83686-6008
US

IV. Provider business mailing address

6225 N MEEKER PLACE SUITE 130
BOISE ID
83713-1579
US

V. Phone/Fax

Practice location:
  • Phone: 208-947-7002
  • Fax: 208-947-7003
Mailing address:
  • Phone: 208-947-7002
  • Fax: 208-947-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID GILES
Title or Position: CEO/MEDICAL DIRECTOR
Credential: M.D.
Phone: 208-947-7002