DIAGNOSTIC IMAGING SERVICE OF IDAHO (NPI# 1508875360) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508875360 |
| Entity Type | Organization |
| Organization Name | DIAGNOSTIC IMAGING SERVICE OF IDAHO |
| Practice Address |
1951 Bench Rd Suite F Pocatello ID 83201-2073 |
| Practice Telephone | 2082370977 |
| Practice Fax Number | 2082370985 |
| Mailing Telephone | 2082370977 |
| Mailing Fax Number | 2082370985 |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2012-06-18 |
| Authorized Official Name | MR. JAMES JAY EVERSON (OWNER) |
| Authorized Official Telephone | 2082370977 |
| Authorized Official Credential | RDMS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0208X |
Clinic/Center Specialization: Radiology, Mobile |
Ambulatory Health Care Facilities | ||
| Y | 2471C3402X |
Radiologic Technologist Specialization: Radiography |
Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 804301300 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Diagnostic Imaging Service of Idaho | 1951 Bench Road, Suite F, Pocatello, ID 83201 |
| Street Address |
1951 BENCH RD SUITE F |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-2073 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982690863 | William G Sabel | Nurse Practitioner | 1951 Bench Rd, Suite B, Pocatello, ID 83201-2073 | 2005-09-26 |
| 1528414513 | Mandy Smith | Physical Therapy Assistant | 1951 Bench Rd, Suite E, Pocatello, ID 83201-2013 | 2016-05-09 |
| 1184083818 | Nicolette Hampton | Nurse Practitioner | 1951 Bench Rd, Ste B, Pocatello, ID 83201-2013 | 2016-02-23 |
| 1306105598 | Dna With Tina LLC | Nurse Practitioner | 1951 Bench Rd, Pocatello, ID 83201-2073 | 2012-05-09 |
| 1164717419 | Zachary Bryant Warnock | Family Medicine | 1951 Bench Rd, Suite B, Pocatello, ID 83201-2013 | 2011-06-15 |
| 1548581390 | John Abraham Fenstermaker | Family Medicine | 1951 Bench Rd, Suite B, Pocatello, ID 83201-2013 | 2010-06-16 |
| 1922236454 | Blaine Olsen | Family Medicine | 1951 Bench Rd, Ste B, Pocatello, ID 83201-2073 | 2009-06-23 |
| 1730340365 | Travis Dale Nielsen | Family Medicine | 1951 Bench Rd, Suite B, Pocatello, ID 83201-2073 | 2008-06-17 |
| 1619095734 | Gate City Physical Therapy | Physical Therapist | 1951 Bench Rd, Suite E, Pocatello, ID 83201-2073 | 2007-03-27 |
| 1477625283 | Highland Physical Therapy LLC | Specialist | 1951 Bench Rd, Suite E, Pocatello, ID 83201 | 2006-11-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 2471C3402X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| Specialization | Radiography |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457713588 | Jennifer Ann Gould | Radiologic Technologist | 907 Ryan Street, Chubbuck, ID 83202 | 2016-03-28 |
| 1316360985 | Patrick Glascock | Radiologic Technologist | 5260 W Hayden Ave, Rathdrum, ID 83858-9467 | 2014-01-31 |
| 1003146333 | April Virginia Riddle | Radiologic Technologist | 815 N 5th St Apt 1, Coeur D Alene, ID 83814-3061 | 2010-01-08 |
| 1760044424 | Phillip Marlowe | Radiologic Technologist | 3422 S 15th E, Idaho Falls, ID 83404-8262 | 2019-07-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.