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General NPI Number Information
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NPI Number | 1518737196
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Entity Type | Organization
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Legal Business Name | SELKIRK DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 8152 N WAYNE BLVD
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City | HAYDEN
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State | ID
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Zip | 83835-5031
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Country | US
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Telephone | 509-294-2497
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 743
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City | HAYDEN
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State | ID
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Zip | 83835-0743
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Country | US
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Telephone | 509-979-2570
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Fax |
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Authorized Official
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Title or Position | OWNER/SONOGRAPHER
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Name | CARRIE ANN DAY
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Credential | RDMS
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Telephone | 509-294-2497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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