Intermountain Diagnostics, Inc.

Primary specialty

Sonography Specialist/Technologist CardiovascularTaxonomy code 246XS1301X

License

NONE GIVEN IN IDAHO Issued in ID

Legal business name

INTERMOUNTAIN DIAGNOSTICS, INC.

Practice address

200 N 4TH St
Suite 15
Boise, ID 83702-6001

Phone

(208) 331-0436

Fax

(208) 424-8501

NPI assigned

Sep 21, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

L. Kathleen Cammack

Title

Billing Agent

Phone

(208) 337-4254

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154429058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N 4TH ST",
            "address_2": "SUITE 15",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026001",
            "telephone_number": "208-331-0436",
            "fax_number": "208-424-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N 4TH ST",
            "address_2": "SUITE 15",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026001",
            "telephone_number": "208-331-0436",
            "fax_number": "208-424-8501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN DIAGNOSTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CAMMACK",
        "authorized_official_first_name": "L. KATHLEEN",
        "authorized_official_title_or_position": "BILLING AGENT",
        "authorized_official_telephone_number": "208-337-4254"
    },
    "taxonomies": [
        {
            "code": "246XS1301X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist Cardiovascular, Sonography",
            "state": "ID",
            "license": "NONE GIVEN IN IDAHO",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMAP (OREGON MEDICAL)",
            "identifier": "170283",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8D244",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED MINE WORKERS",
            "identifier": "1538377",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010017912",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sonography Specialist/Technologist Cardiovascular in Boise, ID
• Providers in Boise, ID by specialty
• Sonography Specialist/Technologist Cardiovascular in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.