Healthcare Provider Details

I. General information

NPI: 1003774522
Provider Name (Legal Business Name): MIDVALLEY IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 EAST VALLEY ROAD SUITE 102
BASALT CO
81621
US

IV. Provider business mailing address

401 CASTLE CREEK ROAD COMPLIANCE OFFICE
ASPEN CO
81611-1159
US

V. Phone/Fax

Practice location:
  • Phone: 970-544-1260
  • Fax:
Mailing address:
  • Phone: 970-544-1551
  • Fax: 970-544-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BRAIN
Title or Position: CFO
Credential:
Phone: 970-544-1220