Provider Demographics
NPI:1548879943
Name:HERITAGE IMAGING, INC.
Entity type:Organization
Organization Name:HERITAGE IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:EWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-947-7000
Mailing Address - Street 1:12554 W. BRIDGER ST. SUITE 118
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1582
Mailing Address - Country:US
Mailing Address - Phone:208-947-7000
Mailing Address - Fax:208-947-6942
Practice Address - Street 1:12554 W. BRIDGER ST. SUITE 118
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1582
Practice Address - Country:US
Practice Address - Phone:208-947-7000
Practice Address - Fax:208-947-6942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile