Provider Demographics
NPI:1265489785
Name:DIAGNOSTIC HEALTH CORPORATION
Entity Type:Organization
Organization Name:DIAGNOSTIC HEALTH CORPORATION
Other - Org Name:TREASURE VALLEY IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-685-5000
Mailing Address - Street 1:2764 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1702
Mailing Address - Country:US
Mailing Address - Phone:205-685-5116
Mailing Address - Fax:205-262-8820
Practice Address - Street 1:8800 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8205
Practice Address - Country:US
Practice Address - Phone:208-373-5012
Practice Address - Fax:208-373-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1790360Medicare PIN