1881649234 NPI number — MRI MOBILE HOLDINGS LIMITED PARTNERSHIP

Table of content: (NPI 1881649234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881649234 NPI number — MRI MOBILE HOLDINGS LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MRI MOBILE HOLDINGS LIMITED PARTNERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881649234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6225 N MEEKER PLACE
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83713-1579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-947-7002
Provider Business Mailing Address Fax Number:
208-947-7001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1512 12TH AVENUE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83686-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-947-7002
Provider Business Practice Location Address Fax Number:
208-947-7003
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/MEDICAL DIRECTOR
Authorized Official Telephone Number:
208-947-7002

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002641800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 070904 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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