Basic Information
| Provider Information | |||||||||
| NPI: | 1912349754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSIGHT RADIOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 RED WING TER | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809063239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194731766 | ||||||||
| FaxNumber: | 9706670847 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 BENEDICTA AVE | ||||||||
| Address2: | |||||||||
| City: | TRINIDAD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810822005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7198468081 | ||||||||
| FaxNumber: | 7198468082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2013 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUFKIN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7194731766 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | CO 18311 | CO | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 99888271 | 05 | CO | MEDICAID |