Organization
IDAHO INDEPENDENT MRI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK L SURBAUGH MD (OWNER)
(208) 732-1205
Entity
Organization
Contact information
Practice address
562 SHOUP AVE W, TWIN FALLS, ID 83301-5029
(208) 732-1205
Mailing address
562 SHOUP AVE W, TWIN FALLS, ID 83301-5029
(208) 732-1205
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
07/28/2006
Last updated
08/22/2020
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