Idaho Independent MRI LLC

Primary specialty

Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X

Legal business name

IDAHO INDEPENDENT MRI LLC

Practice address

562 Shoup Ave W
Twin Falls, ID 83301-5029

Phone

(208) 732-1205

NPI assigned

Jul 28, 2006

Organization subpart

No

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

Authorized official

Name

Frederick L Surbaugh, MD

Title

Owner

Phone

(208) 732-1205

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255345765",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO INDEPENDENT MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2020-08-22",
        "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": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mobile Radiology Clinic/Center in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Mobile Radiology Clinic/Center 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.