Organization
INTERMOUNTAIN DIAGNOSTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
L. KATHLEEN CAMMACK (BILLING AGENT)
(208) 337-4254
Entity
Organization
Contact information
Practice address
200 N 4TH ST, SUITE 15, BOISE, ID 83702-6001
(208) 331-0436
(208) 424-8501
Mailing address
200 N 4TH ST, SUITE 15, BOISE, ID 83702-6001
(208) 331-0436
(208) 424-8501
Taxonomy
Speciality
Code
Description
License number
State
246XS1301X
Sonography Specialist/Technologist Cardiovascular
Primary
NONE GIVEN IN IDAHO
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010017912
BLUE SHIELD
ID
01
—
1538377
UNITED MINE WORKERS
ID
01
—
170283
OMAP (OREGON MEDICAL)
ID
01
—
8D244
BLUE CROSS
ID
Enumeration date
09/21/2006
Last updated
08/22/2020
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