PHOENIX RADIOLOGY, PLLC; NPI #1164493334

Contact Information

PHOENIX RADIOLOGY, PLLC

415 6TH ST
LEWISTON, ID 83501-2431

Phone: 208-799-5335
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Vascular & Interventional Radiology	2085R0204X	94	Physician/Interventional Radiology
Diagnostic Radiology	2085R0202X	30	Physician/Diagnostic Radiology

Indicates primary specialty

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NPI Profile & details for PHOENIX RADIOLOGY, PLLC

NPI Number 1164493334

LBN Legal business name PHOENIX RADIOLOGY, PLLC

Authorized official MARK PETERSON - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 01/27/2006

Last updated 09/11/2025 - About 9 months ago

Identifiers

WA	Medicaid	7124605
	Other	DC3860	RAILROAD MEDICARE
ID	Other	8J679	BLUE CROSS OF IDAHO
ID	Other	000010148406	REGENCE BS OF IDAHO
WA	Other	0192979	LABOR & INDUSTRIES

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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PHOENIX RADIOLOGY, PLLC

Contact Information

Specialty

Vascular & Interventional Radiology

Diagnostic Radiology

NPI Profile & details for PHOENIX RADIOLOGY, PLLC

Reviews for PHOENIX RADIOLOGY, PLLC