Provider Demographics
NPI:1366422248
Name:SANDCREEK ECHO, INC.
Entity type:Organization
Organization Name:SANDCREEK ECHO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS,RVT
Authorized Official - Phone:208-529-2561
Mailing Address - Street 1:2050 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6490
Mailing Address - Country:US
Mailing Address - Phone:208-529-2561
Mailing Address - Fax:208-529-2568
Practice Address - Street 1:2050 E 25TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6490
Practice Address - Country:US
Practice Address - Phone:208-529-2561
Practice Address - Fax:208-529-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8D780OtherBLUE CROSS
ID000010029412OtherBLUE SHIELD
ID000010029412OtherBLUE SHIELD