Provider Demographics
NPI:1740225531
Name:MEDICAL IMAGING ASSOCIATES OF IDAHO FALLS, INC
Entity Type:Organization
Organization Name:MEDICAL IMAGING ASSOCIATES OF IDAHO FALLS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-218-9368
Mailing Address - Street 1:PO BOX 200338
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0338
Mailing Address - Country:US
Mailing Address - Phone:208-715-5220
Mailing Address - Fax:208-523-2025
Practice Address - Street 1:2265 E SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7598
Practice Address - Country:US
Practice Address - Phone:208-529-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002435500Medicaid
CD9692OtherRAILROAD MEDICARE
CD9692OtherRAILROAD MEDICARE
ID002435500Medicaid
ID1371462Medicare PIN