Basic Information
| Provider Information | |||||||||
| NPI: | 1609117225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLATTE VALLEY MEDICAL IMAGING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1606 PRAIRIE CENTER PKWY STE 130 | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806014004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034983618 | ||||||||
| FaxNumber: | 3034983629 | ||||||||
| Practice Location | |||||||||
| Address1: | 1606 PRAIRIE CENTER PKWY STE 130 | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806014004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034983618 | ||||||||
| FaxNumber: | 3034983629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2013 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | FANSELAU | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3034983618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.