Healthcare Provider Details

I. General information

NPI: 1841547395
Provider Name (Legal Business Name): INTRA-OPERATIVE MONITORING INNOVATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 FILLMORE STREET PMB 5757
TWIN FALLS ID
83303-5757
US

IV. Provider business mailing address

PO BOX 5757
TWIN FALLS ID
83303-5757
US

V. Phone/Fax

Practice location:
  • Phone: 801-706-2634
  • Fax: 208-324-1906
Mailing address:
  • Phone: 801-706-2634
  • Fax: 208-324-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD S WILLIAMS
Title or Position: PRESIDENT
Credential: BS, CER.A.T.
Phone: 801-706-2634