MOUNTAIN VALLEY IMAGING LLC (NPI# 1578789525) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578789525 |
| Entity Type | Organization |
| Organization Name | MOUNTAIN VALLEY IMAGING LLC |
| Practice Address |
450 E Main St Rexburg ID 83440-2048 |
| Mailing Address |
Po Box 31 450 East Main Rexburg ID 83440-0031 |
| Practice Telephone | 2083596508 |
| Practice Fax Number | 2083563066 |
| Mailing Telephone | 2083596508 |
| Mailing Fax Number | 2083563066 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2008-05-06 |
| Authorized Official Name | DR. DAVID VICTOR HANSEN (OWNER) |
| Authorized Official Telephone | 2083596508 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | 1156471-00 | 05 | |
| ID | BLUE CROSS | 71910 | 01 |
| Street Address |
450 E MAIN ST |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-2048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639111206 | Madison Physician Services | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2006-06-11 |
| 1396352142 | Karissa Thueson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2020-09-25 |
| 1376192674 | David Howard Anderson | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2019-09-09 |
| 1124676663 | Susan B Clark | Dietitian, Registered | 450 E Main St, Rexburg, ID 83440-2048 | 2019-08-28 |
| 1790278760 | Allen Terry Miller | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-13 |
| 1831682194 | Dorsie Thomas Sullenger | Pharmacist | 450 E Main St, Rexburg, ID 83440-2048 | 2018-06-12 |
| 1184122756 | Steven Craig Pierce | Physician Assistant | 450 E Main St, Rexburg, ID 83440-2048 | 2018-01-29 |
| 1215471065 | Troy Hanson | Nurse Practitioner | 450 E Main St, Rexburg, ID 83440-2048 | 2016-12-13 |
| 1346692605 | University of Utah Pediatric Services | Pediatrics | 450 E Main St, Rexburg, ID 83440-2048 | 2016-07-11 |
| 1871941724 | Justin Shippen | Family Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2016-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
| Find all providers in zip 83440 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538277629 | David Victor Hansen | Radiology | 450 E Main St, Rexburg, ID 83440-2048 | 2006-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518597285 | Katie Clegg | Radiology | 593 W 24th St, Burley, ID 83318-2803 | 2020-01-22 |
| 1376920553 | Creighton Lewis | Radiology | 500 West Fort St. #111r, Boise Vamc, Boise, ID 83702 | 2015-04-27 |
| 1598176448 | Derek A Khorsand | Radiology | Kootenai Health, 2003 Kootenai Way, Coeur D'alene, ID 83814 | 2014-05-14 |
| 1578903191 | Miriam Bryna Hulkower | Radiology | 1839 N Govt Way Ste B, Coeur D Alene, ID 83814-3454 | 2013-06-27 |
| 1750647913 | Philip John Dougherty | Radiology | 700 W Ironwood Dr Ste 175, Coeur D Alene, ID 83814-4401 | 2012-04-02 |
| 1356510143 | Newell Kay Richardson | Radiology | 2088 E 49th South, Idaho Falls, ID 83404-7649 | 2008-02-26 |
| 1477733574 | Cameron J Evans | Radiology | 4121 N 2600 E, Filer, ID 83328-5155 | 2007-11-06 |
| 1295926061 | Michael Modica | Radiology | 877 W Main St, Suite 603, Boise, ID 83702-5883 | 2007-08-07 |
| 1972709590 | Stephen Arthur Sherman | Radiology | 4685 Flora Dr, Pocatello, ID 83204-4568 | 2007-06-21 |
| 1891999165 | Vidvuds Bandrevics | Radiology | 102 Canyon Rd, Hailey, ID 83333-5067 | 2007-06-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.