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General NPI Number Information
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NPI Number | 1851196299
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Entity Type | Organization
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Legal Business Name | PLATTE VALLEY MOBILE IMAGING LLC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 2900 W E ST
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City | NORTH PLATTE
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State | NE
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Zip | 69101-4899
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Country | US
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Telephone | 308-534-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 20000 E FORT MCPHERSON RD
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City | MAXWELL
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State | NE
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Zip | 69151-1032
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Country | US
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Telephone | 308-660-3397
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SAMANTHA DESTEFANO
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Credential |
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Telephone | 308-660-3397
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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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