Provider Demographics
NPI:1023075876
Name:MISSISSIPPI VALLEY IMAGING, LLC
Entity type:Organization
Organization Name:MISSISSIPPI VALLEY IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-344-6600
Mailing Address - Street 1:3385 DEXTER CT
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-344-6600
Mailing Address - Fax:563-344-6751
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:SUITE 102A
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-344-6600
Practice Address - Fax:563-344-6751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00028171OtherRAILROAD MEDICARE
IA0294256Medicaid
IAP00028171OtherRAILROAD MEDICARE