Provider Demographics
NPI:1881649234
Name:MRI MOBILE HOLDINGS LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:MRI MOBILE HOLDINGS LIMITED PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-947-7002
Mailing Address - Street 1:6225 N MEEKER PLACE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1579
Mailing Address - Country:US
Mailing Address - Phone:208-947-7002
Mailing Address - Fax:208-947-7001
Practice Address - Street 1:1512 12TH AVENUE ROAD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6008
Practice Address - Country:US
Practice Address - Phone:208-947-7002
Practice Address - Fax:208-947-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002641800Medicaid
OR070904Medicaid
ORR108389Medicare PIN
ID002641800Medicaid
ID1790146Medicare PIN