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General NPI Number Information
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NPI Number | 1003774522
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Entity Type | Organization
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Legal Business Name | MIDVALLEY IMAGING CENTER, LLC
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 1460 EAST VALLEY ROAD SUITE 102
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City | BASALT
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State | CO
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Zip | 81621
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Country | US
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Telephone | 970-544-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 401 CASTLE CREEK ROAD COMPLIANCE OFFICE
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City | ASPEN
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State | CO
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Zip | 81611-1159
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Country | US
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Telephone | 970-544-1551
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Fax | 970-544-7698
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Authorized Official
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Title or Position | CFO
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Name | DAVID BRAIN
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Credential |
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Telephone | 970-544-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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