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General NPI Number Information
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NPI Number | 1184017022
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Entity Type | Organization
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Legal Business Name | PARTNERS IN THE IMAGING ENTERPRISE, LLC
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 5171 S SEEWEEWANA CT
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City | HARRISON
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State | ID
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Zip | 83833-6051
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Country | US
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Telephone | 208-771-0641
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 639
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City | COEUR D ALENE
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State | ID
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Zip | 83816-0639
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Country | US
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Telephone | 208-771-0641
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. PAUL EDWARD BERGER
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Credential | M.D.
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Telephone | 208-771-0641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M6950
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License Number State | ID
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