Provider Demographics
NPI:1497518096
Name:BOISE IMAGING SOLUTIONS LLC
Entity Type:Organization
Organization Name:BOISE IMAGING SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TANGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALOOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-636-5055
Mailing Address - Street 1:1600 W BROADWAY RD STE 155
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1138
Mailing Address - Country:US
Mailing Address - Phone:949-487-9500
Mailing Address - Fax:
Practice Address - Street 1:1351 W PINE AVE STE A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2010
Practice Address - Country:US
Practice Address - Phone:949-487-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier