1679513196 NPI number — RADIOLOGY IMAGING ASSOCIATES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679513196 NPI number — RADIOLOGY IMAGING ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY IMAGING ASSOCIATES, PC
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:
1679513196
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:
06/07/2006

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: 1679513196 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201053620 . This is a "PRES SALUD MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: CO1609 . This is a "HEALTHNET NE RIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 107475000 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196643002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000901750 0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8161045 . This is a "AETNA RIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: G9020 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0560060 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679513196 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100370940B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4220042 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 074088802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1528962 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: MPG0457 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: QPB657 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: RA22004 . This is a "BCBS RIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 695538 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD2044 . This is a "RR MEDICARE RIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100006790A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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