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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
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