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Organization
IMAGING CENTER OF IDAHO, LLC
Active
Organization
IMAGING CENTER OF IDAHO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY F. CLARK (CEO)
(208) 455-7482
Entity
Organization
Contact information
Practice address
4519 ENTERPRISE WAY, CALDWELL, ID 83605-8086
(208) 455-7482
(208) 455-7538
Mailing address
PO BOX 4813, BOISE, ID 83711-4813
(208) 455-7482
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
08/22/2008
Last updated
01/12/2009
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