Mountain Telerad, PLLC

Primary specialty

Radiologic TechnologistTaxonomy code 247100000X

Legal business name

MOUNTAIN TELERAD, PLLC

Practice address

4519 Enterprise Way
Caldwell, ID 83605

Phone

(208) 455-7482

Fax

(208) 455-7538

NPI assigned

Aug 17, 2007

Last updated

Aug 17, 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

Mr. Micheal Brent Johnson, D.O.

Title

Owner

Phone

(208) 455-7482

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187308800000",
    "number": "1821280371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 VICTOR GUST DR",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836471654",
            "telephone_number": "208-580-9524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4519 ENTERPRISE WAY",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "83605",
            "telephone_number": "208-455-7482",
            "fax_number": "208-455-7538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN TELERAD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-17",
        "last_updated": "2007-08-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MICHEAL",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-455-7482",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiologic Technologist in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Radiologic Technologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.