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General NPI Number Information
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NPI Number | 1992860324
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Entity Type | Organization
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Legal Business Name | BEDSIDE XRAY SERVICE INC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 1110 N FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83713-8034
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Country | US
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Telephone | 208-489-6600
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Fax | 208-376-9729
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Provider Business Mailing Address
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Address Line | 1940 S BONITO WAY STE 190
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City | MERIDIAN
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State | ID
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Zip | 83642-5618
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Country | US
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Telephone | 208-287-9420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARMEN UNDERWOOD
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Credential | RT
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Telephone | 208-489-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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