Southern Idaho Radiology PA

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

SOUTHERN IDAHO RADIOLOGY PA

Practice address

260 Falls Ave
Twin Falls, ID 83301-3370

Phone

(208) 737-2192

NPI assigned

Jun 20, 2006

Last updated

Jul 18, 2007By 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

Dr. Robert Wasserstrom, M.D.NPI 1982638037

Title

President

Phone

(208) 734-1177

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert Wasserstrom, M.D.

  • Diagnostic Radiology Physician
  • Twin Falls, ID
  • NPI 1982638037
  Authorized official Same address or phone
• Michael E Holzer, M.D.

  • Diagnostic Radiology Physician
  • Twin Falls, ID
  • NPI 1255361150
  NPD (past)
• Michael P Dixon, M.D.

  • Diagnostic Radiology Physician
  • Eden Prairie, MN
  • NPI 1245264399
  NPD (past)

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184716800000",
    "number": "1295771129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9649",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837074649",
            "telephone_number": "208-472-8102",
            "fax_number": "208-344-1926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 FALLS AVE",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013370",
            "telephone_number": "208-737-2192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN IDAHO RADIOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2007-07-18",
        "status": "A",
        "authorized_official_last_name": "WASSERSTROM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-734-1177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Idaho Hearing & Audiology LLC
• Southern Idaho Home Health & Staffing (BrightStar of South Central & Eastern Idaho)
• Southern Idaho Ophthalmology PLLC
• Southern Idaho Pain Institute P.C.
• Southern Idaho Pain Institute P.C.
• Southern Idaho Vision Alliance,PLLC
• Ryker N Spackman, DPT
• Kaitlyn Sue Spalding
• Nathan Todd Sparks, FNP-BC
• Amy Spaulding

• Diagnostic Radiology Physician in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Diagnostic Radiology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; 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.