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General NPI Number Information
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NPI Number | 1609358761
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Entity Type | Organization
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Legal Business Name | CARDIAC CATH LAB OF IDAHO FALLS
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 3311 VALENCIA DRIVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 415-218-9820
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 POST OAK BLVD STE 1525
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City | HOUSTON
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State | TX
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Zip | 77056-4711
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Country | US
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Telephone | 713-574-1015
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Fax | 832-271-1037
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | ERIC FOURNET
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Credential |
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Telephone | 713-574-1015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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