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General NPI Number Information
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NPI Number | 1366422248
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Entity Type | Organization
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Legal Business Name | SANDCREEK ECHO, INC.
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2050 E 25TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6490
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Country | US
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Telephone | 208-529-2561
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Fax | 208-529-2568
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Provider Business Mailing Address
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Address Line | 2050 E 25TH ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6490
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Country | US
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Telephone | 208-529-2561
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Fax | 208-529-2568
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIMBERLY CARPENTER
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Credential | RDCS,RVT
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Telephone | 208-529-2561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246XS1301X
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Taxonomy Name | Sonography Specialist/Technologist Cardiovascular
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License Number |
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License Number State |
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