1336188234 NPI number — MEDICAL IMAGING OF COLORADO

Table of content: (NPI 1336188234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336188234 NPI number — MEDICAL IMAGING OF COLORADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL IMAGING OF COLORADO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336188234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10800 E GEDDES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-3894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-9190
Provider Business Mailing Address Fax Number:
720-874-4462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10800 E GEDDES AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80112-3895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-761-9190
Provider Business Practice Location Address Fax Number:
720-874-4462
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRILLO
Authorized Official First Name:
GRACEANN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SUPERVISOR
Authorized Official Telephone Number:
720-493-3716

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100370940A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123484600 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18062 . This is a "PRES SALUD MEDICAID MIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4007803 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5797650 . This is a "AETNA MIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: CO1190 . This is a "HEALTHNET NE MIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: CC8768 . This is a "RR MEDICARE MIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: MEW4008 . This is a "BCBS MIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 074088801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8489712601 . This is a "PACIFICARE MIC" identifier . This identifiers is of the category "OTHER".




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