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General NPI Number Information
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NPI Number | 1336475516
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN NEURODIAGNOSTICS INC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 4596 MCCOWIN LN
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City | IDAHO FALLS
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State | ID
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Zip | 83406-8350
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Country | US
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Telephone | 208-524-8372
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Fax |
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Provider Business Mailing Address
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Address Line | 4596 MCCOWIN LANE
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City | IDAHO FALLS
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State | ID
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Zip | 83403
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Country | US
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Telephone | 208-524-8372
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DOTTIE M LAFLIN
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Credential | R.EEG/T, CNIM
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Telephone | 208-528-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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