Idaho Facial Imaging LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

4-D-2095 Issued in ID

Legal business name

IDAHO FACIAL IMAGING LLC

Practice address

8119 Ustick Rd
Suite 101
Boise, ID 83704-5754

Phone

(208) 514-4740

Fax

(208) 376-7012

NPI assigned

Jul 19, 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

Dr. Braden M Stauts, DDS

Title

Owner/Partner

Phone

(208) 514-4740

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437178399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8119 USTICK RD",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045754",
            "telephone_number": "208-514-4740",
            "fax_number": "208-376-7012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8119 USTICK RD",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045754",
            "telephone_number": "208-514-4740",
            "fax_number": "208-376-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO FACIAL IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAUTS",
        "authorized_official_first_name": "BRADEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "208-514-4740",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "ID",
            "license": "4-D-2095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD-MEDIC",
            "identifier": "000010156829",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD-DENTA",
            "identifier": "000010156827",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Idaho Eyelid & Facial Plastic Surgery , PLLC
• Idaho Face & Voice, LLC
• Idaho Family Dental PLLC
• Idaho Family Physicians
• Idaho Family Wellness
• Idaho Federtion of Families (The Brick House)
• Idaho Foot & Ankle Associates

• Radiology Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• 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.