Basic Information
| Provider Information | |||||||||
| NPI: | 1790767416 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IVIEW DIAGNOSTICS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2039 | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810040039 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | FORT MORGAN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807013290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195427891 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | MALONE | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4053218125 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 53704541 | 05 | CO | MEDICAID |