Organization Active NPI

Twin Falls Imaging & Diagnostic Center LLC

  • Clinic/Center
  • Twin Falls, ID
National Provider Identifier
1124185053
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
TWIN FALLS IMAGING & DIAGNOSTIC CENTER LLC
Practice address
562 Shoup Ave W
Twin Falls, ID 83301-5029
Phone
(208) 732-1205
Fax
(208) 736-2413
NPI assigned
Jan 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Frederick L Surbaugh, M.D.
Title
Owner
Phone
(208) 732-1205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

562 Shoup Ave W
Twin Falls, ID 83301-5029

Mailing address

562 Shoup Ave W
Twin Falls, ID 83301-5029
Phone (208) 732-1205

National Provider Directory

National Provider Directory

Locations

562 Shoup Ave W
Twin Falls, ID 83301
Phone (208) 734-0407

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1124185053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 SHOUP AVE W",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015029",
            "telephone_number": "208-732-1205",
            "fax_number": "208-736-2413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 SHOUP AVE W",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015029",
            "telephone_number": "208-732-1205",
            "fax_number": "208-736-2413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWIN FALLS IMAGING & DIAGNOSTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "SURBAUGH",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-732-1205",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.