Healthcare Provider Details

I. General information

NPI: 1134316854
Provider Name (Legal Business Name): COLORADO HEART & BODY IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 W 26TH AVE 110 A
DENVER CO
80211-5314
US

IV. Provider business mailing address

2490 W 26TH AVE 110 A
DENVER CO
80211-5314
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-8800
  • Fax: 303-433-1366
Mailing address:
  • Phone: 303-433-8800
  • Fax: 303-433-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number21205
License Number StateCO

VIII. Authorized Official

Name: DR. WILLIAM BLANCHET
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 303-433-8800