Basic Information
| Provider Information | |||||||||
| NPI: | 1831855030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO SPRINGS IMAGING LLC | ||||||||
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| OtherOrganizationName: | COLORADO SPRINGS IMAGING EAST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8610 EXPLORER DR UNIT 300 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809201036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7199554332 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6616 DALBY DR STE 160 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809239586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195057200 | ||||||||
| FaxNumber: | 7195057205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2021 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | BENSON | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7199554332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/03/2022 | ||||||||
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.