NPI 1821280371

Mountain Telerad, PLLC

Organisation Radiologic Technologist Caldwell, ID

Practice location

Address: 4519 Enterprise Way, Caldwell, ID 83605
Phone: (208) 455-7482
Fax: (208) 455-7538
Mailing address: 141 Victor Gust Dr, Mountain Home, ID 83647-1654

Authorised official

Name: Micheal Brent Johnson
Title: Owner
Phone: (208) 455-7482

Registered specialties

Radiologic Technologist Primary

Technologists, Technicians & Other Technical Service Providers Taxonomy 247100000X

Other Radiologic Technologist providers in Idaho →

Registry record

NPI: 1821280371
Entity type: Organization
NPI issued: 17 Aug 2007
Record last updated: 17 Aug 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.