MEDICARE: COLORADO OPEN IMAGING, LLC

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	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist

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	:	1538162581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO OPEN IMAGING, LLC

Provider Business Mailing Address
First Line	:	1120 W SOUTH BOULDER RD
Second Line	:	STE 101
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8952
Country	:	US
Telephone Number	:	303-926-5466
Fax Number	:	303-926-5461

Provider Business Practice Location Address
First Line	:	1120 W SOUTH BOULDER RD
Second Line	:	STE 101
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8952
Country	:	US
Telephone Number	:	303-926-5466
Fax Number	:	303-926-5461

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MRS. MICHELLE DOUGLAS
Credential	:
Telephone Number	:	502-477-1815

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/22/2020

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Directions to “COLORADO OPEN IMAGING, LLC ” Practice Location

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