Organization
MOUNTAIN VALLEY IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID VICTOR HANSEN M.D. (OWNER)
(208) 359-6508
Entity
Organization
Contact information
Practice address
450 E MAIN ST, REXBURG, ID 83440-2048
(208) 359-6508
(208) 356-3066
Mailing address
PO BOX 31, 450 EAST MAIN, REXBURG, ID 83440-0031
(208) 359-6508
(208) 356-3066
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1156471-00
—
WY
01
—
71910
BLUE CROSS
ID
Enumeration date
04/18/2007
Last updated
05/06/2008
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