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General NPI Number Information
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NPI Number | 1851384416
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Entity Type | Organization
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Legal Business Name | RADIOLOGY ASSOCIATES OF NORTH IDAHO, PA
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Dates
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Enumeration Date | 08/29/2005
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 700 W IRONWOOD DR STE 175
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4401
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Country | US
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Telephone | 208-625-6309
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Fax | 208-625-6310
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Provider Business Mailing Address
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Address Line | 700 W IRONWOOD DR STE 175
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4401
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Country | US
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Telephone | 208-625-6309
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Fax | 208-625-6310
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. SCOTT VENERA
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Credential |
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Telephone | 208-625-6309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology 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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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