Healthcare Provider Details

I. General information

NPI: 1407077100
Provider Name (Legal Business Name): COLORADO INFRARED IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S CLARKSON ST SUITE 308
DENVER CO
80210-1625
US

IV. Provider business mailing address

1221 S CLARKSON ST SUITE 308
DENVER CO
80210-1625
US

V. Phone/Fax

Practice location:
  • Phone: 720-208-0725
  • Fax: 720-208-0730
Mailing address:
  • Phone: 720-208-0725
  • Fax: 720-208-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1730
License Number StateCO

VIII. Authorized Official

Name: DR. TIMOTHY D. CONWELL
Title or Position: OWNER
Credential: DC
Phone: 720-208-0725