Basic Information
| Provider Information | |||||||||
| NPI: | 1184855082 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEA CHASE RADIOLOGY, LLC | ||||||||
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| Address1: | PO BOX 7704 | ||||||||
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| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805370704 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 448 E 1ST ST | ||||||||
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| City: | SALIDA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812012804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195308218 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2009 | ||||||||
| LastUpdateDate: | 07/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | WARDROP | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9706632742 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.