1639122781 NPI number — E PLUS PET IMAGING X LP

Table of content: (NPI 1639122781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639122781 NPI number — E PLUS PET IMAGING X LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E PLUS PET IMAGING X LP
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:
PET IMAGING OF WHEAT RIDGE
Provider Other Organization Name Type Code:
3
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:
1639122781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8550 W 38TH AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80033-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-407-0444
Provider Business Mailing Address Fax Number:
720-407-0446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8550 W 38TH AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WHEAT RIDGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80033-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-407-0444
Provider Business Practice Location Address Fax Number:
720-407-0446
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RHYMER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
COO OF GENERAL PARTNER
Authorized Official Telephone Number:
615-467-7415

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60087765 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00179372 . This is a "RRMEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 670772 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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