Provider Demographics
NPI:1710089636
Name:INSIGHT DIAGNOSTIC IMAGING PA
Entity Type:Organization
Organization Name:INSIGHT DIAGNOSTIC IMAGING PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-773-6400
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-0758
Mailing Address - Country:US
Mailing Address - Phone:208-773-6400
Mailing Address - Fax:208-773-6800
Practice Address - Street 1:3911 CASTLEVALE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7807
Practice Address - Country:US
Practice Address - Phone:509-457-4210
Practice Address - Fax:509-457-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID207RC0000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA15502Medicare UPIN