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General NPI Number Information
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NPI Number | 1316003726
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Entity Type | Organization
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Legal Business Name | ADVANCED OPEN IMAGING BOISE LLC
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3581 EAST OVERLAND RD
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-846-7494
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Fax | 208-846-7496
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Provider Business Mailing Address
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Address Line | PO BOX 1355
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City | LYNNWOOD
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State | WA
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Zip | 98046-1355
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Country | US
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Telephone | 425-771-8161
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Fax | 425-771-7929
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Authorized Official
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Title or Position | CO-MANAGER
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Name | MR. MARK PARKER JONES
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Credential |
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Telephone | 425-771-8161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | ID
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