Organization
INTERMOUNTAIN MEDICAL IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE BALDWIN (EXECUTIVE DIRECTOR)
(208) 384-9060
Entity
Organization
Contact information
Practice address
927 W MYRTLE ST, BOISE, ID 83702-7061
(208) 367-7510
(208) 367-6367
Mailing address
877 W MAIN ST STE 603, BOISE, ID 83702-6070
(208) 954-8175
(208) 384-9023
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806456500
—
ID
Enumeration date
05/15/2006
Last updated
10/31/2023
Update your record
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