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General NPI Number Information
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NPI Number | 1780620633
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Entity Type | Organization
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Legal Business Name | CALDWELL RADIOLOGICAL ASSOCIATES PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 1717 ARLINGTON AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4802
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Country | US
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Telephone | 208-455-3730
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9649
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City | BOISE
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State | ID
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Zip | 83707-4649
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Country | US
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Telephone | 207-472-8108
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Fax | 208-344-1926
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORELI SMITH
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Credential | M.D.
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Telephone | 208-455-3730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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