Basic Information
| Provider Information | |||||||||
| NPI: | 1609199140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FCID COLORADO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 S HARBOR CITY BLVD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329011938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217250090 | ||||||||
| FaxNumber: | 3213080635 | ||||||||
| Practice Location | |||||||||
| Address1: | 485 LINDBERGH DRIVE | ||||||||
| Address2: | |||||||||
| City: | GYPSUM | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707772100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2010 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | BITTAR | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 3217250090 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FCID HOLDINGS, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
No ID Information.