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Organization
ELEVATION MEDICAL IMAGING EVANSTON
Active
Organization
ELEVATION MEDICAL IMAGING EVANSTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN ANDRIKOPOULOS (DIRECTOR OFFICER)
(307) 444-4215
Entity
Organization
Contact information
Practice address
1485 STATE HIGHWAY 150 S, EVANSTON, WY 82930-5344
(307) 444-4215
(307) 444-4219
Mailing address
PO BOX 2393, IDAHO FALLS, ID 83403-2393
(800) 338-5378
(208) 523-8978
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
NULL
261QR0200X
Radiology Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/13/2020
Last updated
09/16/2021
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