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General NPI Number Information
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NPI Number | 1679430110
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Entity Type | Organization
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Legal Business Name | PREFERRED IMAGE
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 460 N STATE RD
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City | LAKE VIEW
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State | IA
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Zip | 51450-7307
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Country | US
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Telephone | 712-830-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 460 N STATE RD
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City | LAKE VIEW
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State | IA
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Zip | 51450-7307
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Country | US
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Telephone | 712-830-3170
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MARK MOGENSEN
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Credential | PAC
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Telephone | 712-830-4840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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