Healthcare Provider Details

I. General information

NPI: 1821933003
Provider Name (Legal Business Name): GOLD COAST MEDICAL DIAGNOSTICS CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4999 E KENTUCKY AVE
DENVER CO
80246-3901
US

IV. Provider business mailing address

4999 E KENTUCKY AVE
DENVER CO
80246-3901
US

V. Phone/Fax

Practice location:
  • Phone: 720-551-4112
  • Fax:
Mailing address:
  • Phone: 720-551-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: OSSAMAH ABAIDAT
Title or Position: BILLING MANAGER
Credential:
Phone: 720-551-4112