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General NPI Number Information
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NPI Number | 1740225531
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Entity Type | Organization
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Legal Business Name | MEDICAL IMAGING ASSOCIATES OF IDAHO FALLS, INC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 2265 E SUNNYSIDE RD
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7598
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Country | US
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Telephone | 208-529-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 12554 RIATA VISTA CIR
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City | AUSTIN
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State | TX
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Zip | 78727-6431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP, PROVIDER ENROLLMENT
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Name | KAREN MARIE VAUGHN
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Credential |
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Telephone | 330-620-0384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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