1407077100 NPI number — COLORADO INFRARED IMAGING CENTER

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 1407077100 NPI number — COLORADO INFRARED IMAGING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO INFRARED IMAGING CENTER
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:
1407077100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 S CLARKSON ST
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80210-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-208-0725
Provider Business Mailing Address Fax Number:
720-208-0730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 S CLARKSON ST
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80210-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-208-0725
Provider Business Practice Location Address Fax Number:
720-208-0730
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONWELL
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
720-208-0725

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1730 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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