13D0999409 CLIA NUMBER - INTERMOUNTAIN MEDICAL IMAGING

Laboratory Demographics

CLIA Number: 13D0999409

Facility Name: INTERMOUNTAIN MEDICAL IMAGING

Facility Address:
2929 E MAGIC VIEW DR
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 954-8189

Facility Type: Other - OP RADIOLOGY IMAGING CTR

Certificate Type: Waiver

NPI Number: 1790990570

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	13D0999409
LAB Type	Other - OP RADIOLOGY IMAGING CTR
Facility Name	INTERMOUNTAIN MEDICAL IMAGING
Street	2929 E MAGIC VIEW DR
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 954-8189
CertificateType	4
CertificateEffectiveDate	8/26/2022
CertificateExpirationDate	8/25/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024