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NORTH IDAHO IMAGING CENTER

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Company Details

Name: NORTH IDAHO IMAGING CENTER
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 29 Aug 2007 (18 years ago)
Entity Number: 352595
Place of Formation: IDAHO
File Number: 0000352595
ZIP code: 83814
County: Kootenai County
Mailing Address: ANCILLARY SUPPORT SERVICES 2003 LINCOL WAY COEUR D'ALENE, ID 83814

National Provider Identifier

NPI Number:
1457353450

Authorized Person:

Name:
MR. THOMAS J LEGEL
Role:
DELEGATED OFFICIAL
Phone:

Taxonomy:

Selected Taxonomy:
2085R0202X - Diagnostic Radiology Physician
Is Primary:
Yes

Contacts:

Fax:
2086642341
Fax:
2086663217

Form 5500 Series

Employer Identification Number (EIN):
820468053
Plan Year:
2010
Number Of Participants:
37
Sponsors DBA Name:
DBA KOOTENAI OUTPATIENT IMAGING
Sponsors Telephone Number:
Plan Year:
2010
Number Of Participants:
43
Sponsors DBA Name:
DBA KOOTENAI OUTPATIENT IMAGING
Sponsors Telephone Number:
Plan Year:
2009
Number Of Participants:
46
Sponsors DBA Name:
DBA KOOTENAI OUTPATIENT IMAGING
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Initial Filing 0000352595 2007-08-29

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State