Organization
LEWIS CLARK IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVY GWOST RVT, RDMS, RDCS (CO-OWNER)
(360) 391-9311
Entity
Organization
Contact information
Practice address
336 WARNER DR STE B, LEWISTON, ID 83501-4441
(360) 391-9311
(208) 473-7304
Mailing address
336 WARNER DR STE B, LEWISTON, ID 83501-4441
(360) 391-9311
(208) 473-7304
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
12/16/2022
Last updated
06/12/2024
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