1609486299 NPI number — COLORADO SPRINGS RADIOLOGISTS 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 1609486299 NPI number — COLORADO SPRINGS RADIOLOGISTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO SPRINGS RADIOLOGISTS 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:
1609486299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2989
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80901-2989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-593-1799
Provider Business Mailing Address Fax Number:
719-265-3794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7955 FOUNTAIN MESA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80817-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-593-1799
Provider Business Practice Location Address Fax Number:
719-265-3794
Provider Enumeration Date:
08/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BERGESON
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
RADIOLOGIST
Authorized Official Telephone Number:
719-593-1799

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)





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