| Lewis Clark Imaging, LLC | |
|
336 Warner Dr Ste B Lewiston ID 83501-4441 | |
| (360) 391-9311 | |
| (208) 473-7304 |
| Full Name | Lewis Clark Imaging, LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 336 Warner Dr Ste B, Lewiston, Idaho |
| Authorized Official Name and Position | Ivy Gwost (CO-OWNER) |
| Authorized Official Contact | 3603919311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lewis Clark Imaging, LLC 336 Warner Dr Ste B Lewiston ID 83501-4441 Ph: (360) 391-9311 | Lewis Clark Imaging, LLC 336 Warner Dr Ste B Lewiston ID 83501-4441 Ph: (360) 391-9311 |
| NPI Number | 1316659899 |
|---|---|
| Provider Enumeration Date | 12/16/2022 |
| Last Update Date | 06/12/2024 |
| Certification Date | 06/12/2024 |
| Medicare PECOS PAC ID | 2062851678 |
|---|---|
| Medicare Enrollment ID | O20240416001445 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316659899 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 261QR0200X | Clinic/center - Radiology | () | Primary |
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