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General NPI Number Information
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NPI Number | 1710097647
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Entity Type | Organization
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Legal Business Name | VALLEY XRAY LLC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 124 PETERSEN PARKWAY 124 PETERSEN PARKWAY SUITE 2
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City | THAYNE
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State | WY
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Zip | 83127
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Country | US
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Telephone | 307-883-9729
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 135 FAIRVIEW WYOMING 83119 124 PETERSEN PARKWAY SUITE 2
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City | THAYNE
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State | WY
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Zip | 83127
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Country | US
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Telephone | 307-883-9729
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Fax |
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Authorized Official
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Title or Position | RADIOLOGY TECH
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Name | DONALD HENRY GUEAR
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Credential | RT
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Telephone | 307-883-9729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | GN025022
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License Number State | WY
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