OrganizationActive
Innovative Medical Imaging, PLLC
NPI 1962015776 · Diagnostic Radiology Physician · Twin Falls, ID
Provider details
- NPI number
- 1962015776
- Entity type
- Organization
- Primary specialty
- Diagnostic Radiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Stephan Thiede, Authorized Official(541) 334-7550
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
512 Pole Line Rd Ste 1
Twin Falls, ID 83301-6367
Phone: (208) 735-5555
Fax: (208) 735-5556
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 1614
Evansville, IN 47706-0016
Registry dates
- Enumerated
- 2020-08-31
- Last updated
- 2024-02-12
- Certified
- 2024-02-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.