Organization
NORTH IDAHO MRI
Active
Other names
KOOTENAI MRI
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS J LEGEL (CFO)
(208) 666-2000
Entity
Organization
Contact information
Practice address
825 W IRONWOOD DR, COEUR D ALENE, ID 83814-2673
(208) 666-3119
(208) 666-3963
Mailing address
PO BOX 3103, COEUR D ALENE, ID 83816-2525
(208) 666-3119
(208) 666-3963
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010138805
IDAHO MEDICAID
ID
05
—
002642800
—
ID
01
—
84095
BLUE CROSS
ID
Enumeration date
08/26/2005
Last updated
12/28/2009
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