Healthcare Provider Details
I. General information
NPI: 1346833167
Provider Name (Legal Business Name): CHER LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/12/2021
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2750 BROADWAY ST STE 1134
BOULDER CO
80304-3573
US
IV. Provider business mailing address
8610 EXPLORER DR UNIT 300
COLORADO SPRINGS CO
80920-1036
US
V. Phone/Fax
- Phone: 303-416-1350
- Fax: 303-416-1352
- Phone: 719-955-4332
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QR0200X |
| Taxonomy | Radiology Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ANDREW
BENSON
Title or Position: CHIEF REVENUE OFFICE
Credential:
Phone: 719-955-4332