Healthcare Provider Details

I. General information

NPI: 1609117225
Provider Name (Legal Business Name): PLATTE VALLEY MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 PRAIRIE CENTER PKWY STE 130
BRIGHTON CO
80601-4004
US

IV. Provider business mailing address

1606 PRAIRIE CENTER PKWY STE 130
BRIGHTON CO
80601-4004
US

V. Phone/Fax

Practice location:
  • Phone: 303-498-3618
  • Fax: 303-498-3629
Mailing address:
  • Phone: 303-498-3618
  • Fax: 303-498-3629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGG FANSELAU
Title or Position: MANAGER
Credential:
Phone: 303-498-3618