MEDICARE: RADIOLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043206311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	1619 N GREENWOOD ST
Second Line	:	SUITE 103
City	:	PUEBLO
State	:	CO
Zip	:	81003-2644
Country	:	US
Telephone Number	:	719-542-2167
Fax Number	:	719-542-0320

Provider Business Practice Location Address
First Line	:	1619 N GREENWOOD ST
Second Line	:	SUITE 100
City	:	PUEBLO
State	:	CO
Zip	:	81003-2644
Country	:	US
Telephone Number	:	719-542-2167
Fax Number	:	719-542-0320

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	COOKIE HENDERSON
Credential	:	R.T.
Telephone Number	:	719-542-2167

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	04/14/2008

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Directions to “RADIOLOGY ASSOCIATES ” Practice Location

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