Organization Name: | MOUNTAIN TELERAD, PLLC |
NPI Number: | 1821280371 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHEAL BRENT JOHNSON (OWNER) |
Mailing Address: | 4519 Enterprise Way Caldwell |
State: | ID US |
Postal Code: | 83605 |
Phone Number: | 2084557482 |
Fax Number: | 2084557538 |
NPI Enumeration Date: | 08/17/2007 |
NPI Last Update Date: | 08/17/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 247100000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Radiologic Technologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment. |