MEDICARE: FOCUSED ABLATION IMAGING

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	2085B0100X	Body Imaging Physician

General Provider Information

NPI Number	:	1639269988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOCUSED ABLATION IMAGING

Provider Business Mailing Address
First Line	:	1183 S HURON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-3106
Country	:	US
Telephone Number	:	303-810-5823
Fax Number	:	303-698-4374

Provider Business Practice Location Address
First Line	:	7170 SMOKE RANCH RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1103
Country	:	US
Telephone Number	:	303-810-5823
Fax Number	:	303-698-4374

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MICAH GAUTIER
Credential	:
Telephone Number	:	303-810-5823

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	08/22/2020

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