Organization
INNOVATIVE MEDICAL IMAGING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHAN G THIEDE MD (AUTHORIZED OFFICIAL)
(541) 334-7550
Entity
Organization
Contact information
Practice address
512 POLE LINE RD STE 1, TWIN FALLS, ID 83301-6367
(208) 735-5555
(208) 735-5556
Mailing address
PO BOX 1614, EVANSVILLE, IN 47706-0016
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
08/31/2020
Last updated
02/12/2024
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