Organization
MEDICAL IMAGING ASSOCIATES OF IDAHO FALLS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN MARIE VAUGHN (AUTHORIZED OFFICIAL)
(629) 317-1465
Entity
Organization
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 529-6111
Mailing address
PO BOX 85495, CHICAGO, IL 60689-5495
(208) 715-5220
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002435500
—
ID
01
—
CD9692
RAILROAD MEDICARE
—
Enumeration date
06/17/2006
Last updated
03/25/2026
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