Provider Demographics
NPI:1386969285
Name:PALOUSE IMAGING CONSULTANTS, PLLC
Entity type:Organization
Organization Name:PALOUSE IMAGING CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-882-8369
Mailing Address - Street 1:PO BOX 9583
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-0177
Mailing Address - Country:US
Mailing Address - Phone:208-882-8369
Mailing Address - Fax:208-882-1887
Practice Address - Street 1:220 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2203
Practice Address - Country:US
Practice Address - Phone:208-882-8369
Practice Address - Fax:208-882-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1369047Medicare PIN
WAG8891648Medicare PIN