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General NPI Number Information
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NPI Number | 1952377459
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Entity Type | Organization
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Legal Business Name | RADIOLOGY PHYSICIANS OF IDAHO
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 1151 HOSPITAL WAY BLDG B
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City | POCATELLO
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State | ID
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Zip | 83201
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Country | US
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Telephone | 208-233-1187
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Fax | 208-234-3841
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Provider Business Mailing Address
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Address Line | P.O. BOX 2580 1151 HOSPITAL WAY BLDG B
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City | POCATELLO
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State | ID
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Zip | 83201
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Country | US
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Telephone | 208-233-1187
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Fax | 208-234-3841
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN A. LARSEN
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Credential | M.D.
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Telephone | 208-233-1187
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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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