Provider Demographics
NPI:1205516184
Name:FORBUSH, JADE (RDMS)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:FORBUSH
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2776
Mailing Address - Country:US
Mailing Address - Phone:208-539-7399
Mailing Address - Fax:208-417-0882
Practice Address - Street 1:1334 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-2610
Practice Address - Country:US
Practice Address - Phone:208-539-7399
Practice Address - Fax:208-417-0882
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471S1302X
ID1948232085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty