MEDICARE: BEDSIDE XRAY SERVICE 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8A992	OTHER	ID	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000010008741	OTHER	ID	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1992860324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDSIDE XRAY SERVICE INC

Provider Business Mailing Address
First Line	:	1940 S BONITO WAY STE 190
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-5618
Country	:	US
Telephone Number	:	208-287-9420
Fax Number	:

Provider Business Practice Location Address
First Line	:	9460 W FAIRVIEW AVE STE 115
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-8184
Country	:	US
Telephone Number	:	208-489-6600
Fax Number	:	208-922-7439

Authorized Official
Title or Position	:	OWNER
Name	:	CARMEN UNDERWOOD
Credential	:	RT
Telephone Number	:	208-489-6600

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	03/05/2026

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Directions to “BEDSIDE XRAY SERVICE INC ” Practice Location

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