Imaging Center of Idaho, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

IMAGING CENTER OF IDAHO, LLC

Practice address

4519 Enterprise Wy
Caldwell, ID 83605-9999

Phone

(208) 455-7482

Fax

(208) 455-7538

NPI assigned

Jun 12, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Gregory F. Clark, B.S., RT, R

Title

Ceo

Phone

(208) 629-6235

Specialties & licenses 8

Addresses

Locations

Practitioners 5

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

• Michael C Biddulph, MD

  • Diagnostic Radiology Physician
  • Idaho Falls, ID
  • NPI 1760561310
  NPD (past)
• Gerald E Carlson, D.O

  • Specialist
  • Nampa, ID
  • NPI 1053339457
  NPD (past)
• Diane R Newton, M.D.

  • Diagnostic Radiology Physician
  • Boise, ID
  • NPI 1689617797
  NPD (past)
• Paul D Traughber, M.D.

  • Diagnostic Radiology Physician
  • McCall, ID
  • NPI 1538107362
  NPD (past)
• Steven F Merandi, M.D.

  • Diagnostic Radiology Physician
  • El Segundo, CA
  • NPI 1962458000
  NPD (past)

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194480000000",
    "number": "1801090204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4519 ENTERPRISE WAY",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836059999",
            "telephone_number": "208-455-7482",
            "fax_number": "208-455-7538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4519 ENTERPRISE WY",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836059999",
            "telephone_number": "208-455-7482",
            "fax_number": "208-455-7538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGING CENTER OF IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-11-08",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-629-6235",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "B.S., RT, R"
    },
    "taxonomies": [
        {
            "code": "2471B0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Bone Densitometry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471C3401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Computed Tomography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471C3402X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Radiography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471M1202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471M2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Mammography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471S1302X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Sonography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in Caldwell, ID
• Providers in Caldwell, 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 Nov 8, 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.