Organization
NORTH IDAHO IMAGING CENTER
Active
Other names
KOOTENAI OUTPATIENT IMAGING
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS J LEGEL (DELEGATED OFFICIAL)
(208) 666-3200
Entity
Organization
Contact information
Practice address
700 W IRONWOOD DR, SUITE 110, COEUR D ALENE, ID 83814-2656
(208) 666-3200
(208) 666-3217
Mailing address
PO BOX 1335, COEUR D ALENE, ID 83816-1335
(208) 667-9334
(208) 664-2341
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002735600
—
ID
05
—
7058530
—
WA
01
—
86371
BC ID - CDA
ID
01
—
8J422
BC ID - PF
ID
01
—
CR0440
RR MEDICARE
ID
Enumeration date
08/10/2005
Last updated
12/21/2009
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