Provider Demographics
NPI:1851196299
Name:PLATTE VALLEY MOBILE IMAGING LLC
Entity type:Organization
Organization Name:PLATTE VALLEY MOBILE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-660-3397
Mailing Address - Street 1:20000 E FORT MCPHERSON RD
Mailing Address - Street 2:
Mailing Address - City:MAXWELL
Mailing Address - State:NE
Mailing Address - Zip Code:69151-1032
Mailing Address - Country:US
Mailing Address - Phone:308-660-3397
Mailing Address - Fax:
Practice Address - Street 1:2900 W E ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4899
Practice Address - Country:US
Practice Address - Phone:308-534-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty