MEDICARE: MEDICAL IMAGING ASSOCIATES OF IDAHO FALLS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician
2	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CD9692	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740225531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL IMAGING ASSOCIATES OF IDAHO FALLS, INC

Provider Business Mailing Address
First Line	:	PO BOX 85495
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5495
Country	:	US
Telephone Number	:	208-715-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 HOSPITAL WAY
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83201-5175
Country	:	US
Telephone Number	:	208-529-6111
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	KAREN MARIE VAUGHN
Credential	:
Telephone Number	:	629-317-1465

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	03/25/2026

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