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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 B.S., RT, R (CEO)
(208) 629-6235
Entity
Organization
Contact information
Practice address
4519 ENTERPRISE WY, CALDWELL, ID 83605-9999
(208) 455-7482
(208) 455-7538
Mailing address
4519 ENTERPRISE WAY, CALDWELL, ID 83605-9999
(208) 455-7482
(208) 455-7538
Taxonomy
Speciality
Code
Description
License number
State
2471B0102X
Bone Densitometry Radiologic Technologist
—
—
2471C3401X
Computed Tomography Radiologic Technologist
—
—
2471C3402X
Radiography Radiologic Technologist
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
—
—
2471M2300X
Mammography Radiologic Technologist
—
—
2471S1302X
Sonography Radiologic Technologist
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
06/12/2007
Last updated
11/08/2007
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