PHOENIX RADIOLOGY PLLC NPI 1164493334

NPI Information

NPI: 1164493334
Provider Name: PHOENIX RADIOLOGY, PLLC
Classification: Radiology - 2085R0202X
Entity Type: Organization

Specialization: Diagnostic Radiology

Address:
415 6TH ST
LEWISTON, ID
ZIP 83501
Phone: (208) 799-5335
Get Directions

PHOENIX RADIOLOGY, PLLC is a diagnostic radiology radiology in Lewiston, ID. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. PHOENIX RADIOLOGY, PLLC NPI is 1164493334. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

415 6TH ST
LEWISTON, ID
ZIP 83501-431
Phone: (208) 799-5335

The provider's authorized official is Mark W Peterson .
The authorized official title is Owner and has the following contact phone number (208) 743-4393.

The enumeration date for this NPI number is 1/27/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology			Yes
2	2085R0204X	Radiology	Vascular & Interventional Radiology			X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7124605	MEDICAID	WASHINGTON
2	DC3860	OTHER		RAILROAD MEDICARE
3	8J679	OTHER	IDAHO	BLUE CROSS OF IDAHO
4	000010148406	OTHER	IDAHO	REGENCE BS OF IDAHO
5	0192979	OTHER	WASHINGTON	LABOR & INDUSTRIES

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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