Healthcare Provider Details

I. General information

NPI: 1285689596
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING OF COLORADO SPRINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 TUTT BLVD SUITE 120
COLORADO SPRINGS CO
80922-3575
US

IV. Provider business mailing address

PO BOX 21820 DEPT 1425
TULSA OK
74121-1820
US

V. Phone/Fax

Practice location:
  • Phone: 719-380-7226
  • Fax:
Mailing address:
  • Phone: 918-745-2299
  • Fax:

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: DESIREE MARTIN
Title or Position: C.O.O.
Credential:
Phone: 918-596-5185