Provider Demographics
NPI:1902848591
Name:STANDUP MRI OF BOISE, LLC
Entity Type:Organization
Organization Name:STANDUP MRI OF BOISE, LLC
Other - Org Name:BOISE UPRIGHT MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLODKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-887-8788
Mailing Address - Street 1:PO BOX 90875
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92427-1875
Mailing Address - Country:US
Mailing Address - Phone:909-887-8788
Mailing Address - Fax:909-887-6345
Practice Address - Street 1:2082 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6707
Practice Address - Country:US
Practice Address - Phone:208-884-8745
Practice Address - Fax:208-884-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1790333Medicare ID - Type Unspecified