Healthcare Provider Details

I. General information

NPI: 1396936928
Provider Name (Legal Business Name): BLUE VALLEY IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10222 MONROVIA ST
LENEXA KS
66215-1980
US

IV. Provider business mailing address

10222 MONROVIA ST
LENEXA KS
66215-1980
US

V. Phone/Fax

Practice location:
  • Phone: 913-599-4733
  • Fax: 913-599-4866
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL J HAGEMAN
Title or Position: DIRECTOR
Credential:
Phone: 913-599-4733