Provider Demographics
NPI:1346713302
Name:RADIAL FIRST HOLDINGS
Entity Type:Organization
Organization Name:RADIAL FIRST HOLDINGS
Other - Org Name:RADIAL FIRST HEART CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LASSETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-523-3050
Mailing Address - Street 1:PO BOX 2386
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2386
Mailing Address - Country:US
Mailing Address - Phone:208-523-3050
Mailing Address - Fax:
Practice Address - Street 1:2001 S WOODRUFF AVE STE 20
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6373
Practice Address - Country:US
Practice Address - Phone:208-523-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM11673OtherIDAHO LICENSE