Healthcare Provider Details

I. General information

NPI: 1043304181
Provider Name (Legal Business Name): VPS MEDICAL IMAGING PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N CECIL
POST FALLS ID
83854
US

IV. Provider business mailing address

PO BOX 1829
COEUR D ALENE ID
83816
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-9334
  • Fax: 208-664-2341
Mailing address:
  • Phone: 208-667-9334
  • Fax: 208-664-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM-5767
License Number StateID

VIII. Authorized Official

Name: V PETER SEMOGAS
Title or Position: OWNER
Credential: MD
Phone: 208-667-9334