Provider Demographics
NPI:1710097647
Name:VALLEY XRAY LLC
Entity Type:Organization
Organization Name:VALLEY XRAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY TECH
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:GUEAR
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:307-883-9729
Mailing Address - Street 1:PO BOX 135 FAIRVIEW WYOMING 83119
Mailing Address - Street 2:124 PETERSEN PARKWAY SUITE 2
Mailing Address - City:THAYNE
Mailing Address - State:WY
Mailing Address - Zip Code:83127
Mailing Address - Country:US
Mailing Address - Phone:307-883-9729
Mailing Address - Fax:
Practice Address - Street 1:124 PETERSEN PARKWAY
Practice Address - Street 2:124 PETERSEN PARKWAY SUITE 2
Practice Address - City:THAYNE
Practice Address - State:WY
Practice Address - Zip Code:83127
Practice Address - Country:US
Practice Address - Phone:307-883-9729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYGN025022247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty