Provider Demographics
NPI:1740461821
Name:NORTH VALLEY PORTABLE X-RAY
Entity type:Organization
Organization Name:NORTH VALLEY PORTABLE X-RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIN HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:530-895-3178
Mailing Address - Street 1:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-1220
Mailing Address - Country:US
Mailing Address - Phone:530-895-3178
Mailing Address - Fax:530-895-8731
Practice Address - Street 1:2095 RENZ RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CA
Practice Address - Zip Code:95938-9627
Practice Address - Country:US
Practice Address - Phone:530-895-3178
Practice Address - Fax:530-895-8731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-17
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFAC41966335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19531ZOtherBLUE SHIELD
CA630001123OtherRAILROAD MEDICARE
CAXR0599660OtherMEDICAL
CA630001123OtherRAILROAD MEDICARE