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INTERMOUNTAIN MEDICAL IMAGING LLC
NPI 1598524696
Radiology - Diagnostic Radiology in Meridian, ID

Active since March 19, 2024CLIA Certified · 2 labs
875 S VANGUARD WAY STE 100, MERIDIAN, ID 83642(208) 954-8100(208) 947-3322 Get Directions Write a Review

NPPES record last updated: March 21, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Intermountain Medical Imaging Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

INTERMOUNTAIN MEDICAL IMAGING LLC (NPI 1598524696) is a healthcare organization registered as a diagnostic radiology in Meridian, Idaho and active in the NPI registry since March 2024. The organization holds 2 active CLIA laboratory certificates and lists Wayne Baldwin, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1598524696
Entity TypeOrganization
Primary Taxonomy2085R0202X
Legal Business NameINTERMOUNTAIN MEDICAL IMAGING LLC
Location Address875 S VANGUARD WAY STE 100Meridian, ID 83642-8541
Mailing Address877 W Main St Ste 603Boise, ID 83702-6070 · (208) 991-5212
Phone(208) 954-8100
Fax(208) 947-3322
Organization SubpartNo
Authorized OfficialWayne BaldwinExecutive Director · (208) 384-9060
Enumeration DateMarch 19, 2024
Last NPPES UpdateMarch 21, 2024
NPPES CertifiedMarch 21, 2024
✔ NPI 1598524696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRadiology · Diagnostic RadiologyAllopathic & Osteopathic Physicians
Taxonomy Code2085R0202X
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
875 S VANGUARD WAY STE 100, Meridian, ID 83642
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2302541

Intermountain Medical Imaging LLC · Meridian, ID
Active · expires Apr 10, 2028
CLIA Number13D2302541
Laboratory TypePhysician Office
Certificate Effective DateApril 11, 2026
Certificate Expiration DateApril 10, 2028
Laboratory DirectorJohn A. Jackson
Laboratory Phone(208) 954-8100
Laboratory LocationIntermountain Medical Imaging LLC875 S Vanguard Ste 100, Meridian, ID 83642
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 13D0999409

Intermountain Medical Imaging · Meridian, ID
Active · expires Aug 25, 2026
CLIA Number13D0999409
Laboratory TypeOp Radiology Imaging Ctr
Certificate Effective DateAugust 26, 2024
Certificate Expiration DateAugust 25, 2026
Laboratory DirectorBenjamin K. Hom
Laboratory Phone(208) 954-8030
Laboratory LocationIntermountain Medical Imaging2929 E Magic View Dr, Meridian, ID 83642
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Intermountain Medical Imaging LLC's NPI number?

The NPI number for Intermountain Medical Imaging LLC is 1598524696. It was assigned to this organization in the NPPES registry on March 19, 2024.

Where is Intermountain Medical Imaging LLC located?

Intermountain Medical Imaging LLC is located at 875 S Vanguard Way Ste 100, Meridian, ID 83642. The listed phone number is (208) 954-8100.

What is Intermountain Medical Imaging LLC's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.

Does Intermountain Medical Imaging LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Intermountain Medical Imaging LLC was last updated on March 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.