Organization
DIAGNOSTIC IMAGING SERVICE OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES JAY EVERSON RDMS (OWNER)
(208) 237-0977
Entity
Organization
Contact information
Practice address
1951 BENCH RD, SUITE F, POCATELLO, ID 83201-2073
(208) 237-0977
(208) 237-0985
Mailing address
1951 BENCH RD, SUITE F, POCATELLO, ID 83201-2073
(208) 237-0977
(208) 237-0985
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
—
—
261QR0208X
Mobile Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804301300
—
ID
Enumeration date
08/07/2006
Last updated
06/18/2012
Update your record
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