# ELEVATION MEDICAL IMAGING EVANSTON

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184242521
- **Authorized official:** SHAUN ANDRIKOPOULOS (DIRECTOR OFFICER)
- **Authorized official phone:** (307) 444-4215

## Contact information

- **Practice address:** 1485 STATE HIGHWAY 150 S, EVANSTON, WY 82930-5344
- **Practice address phone:** (307) 444-4215
- **Practice address fax:** (307) 444-4219
- **Mailing address:** PO BOX 2393, IDAHO FALLS, ID 83403-2393
- **Mailing address phone:** (800) 338-5378
- **Mailing address fax:** (208) 523-8978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | NULL | — |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/13/2020
- **Last updated:** 09/16/2021