Provider Demographics
NPI:1467709352
Name:A WINDOW WITHIN IMAGING CENTER
Entity Type:Organization
Organization Name:A WINDOW WITHIN IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MIDSTOKKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-263-0776
Mailing Address - Street 1:723 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1486
Mailing Address - Country:US
Mailing Address - Phone:208-263-0776
Mailing Address - Fax:208-263-0772
Practice Address - Street 1:723 PINE ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1486
Practice Address - Country:US
Practice Address - Phone:208-263-0776
Practice Address - Fax:208-263-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty