=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730445214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONSITE DIAGNOSTIC SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2012
-----------------------------------------------------
Last Update Date | 04/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9133 N ORANGE BLOSSOM CT
-----------------------------------------------------
City | HAYDEN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83835-8748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-651-6036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9133 N ORANGE BLOSSOM CT
-----------------------------------------------------
City | HAYDEN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-651-6036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CARRIE ANNE FRANK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-651-6036
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------