1679513196 NPI number — RADIOLOGY IMAGING ASSOCIATES, PC

Table of content: (NPI 1679513196)

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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