Healthcare Provider Details

I. General information

NPI: 1245415629
Provider Name (Legal Business Name): CLINICAL DIAGNOSTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E HARVARD AVE STE 650
DENVER CO
80210-7002
US

IV. Provider business mailing address

845 RAILROAD ST
ELKO NV
89801-3831
US

V. Phone/Fax

Practice location:
  • Phone: 877-753-2468
  • Fax: 775-753-3772
Mailing address:
  • Phone: 877-753-2468
  • Fax: 775-753-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: TROY R. EDEN
Title or Position: OWNER
Credential: PA-C
Phone: 775-753-3770