Healthcare Provider Details

I. General information

NPI: 1891380366
Provider Name (Legal Business Name): MOUNTAIN RADIOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 N 7TH ST
GRAND JUNCTION CO
81501-8209
US

IV. Provider business mailing address

PO BOX 85500
CHICAGO IL
60689-5500
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-7564
  • Fax:
Mailing address:
  • Phone: 970-900-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN MARIE VAUGHN
Title or Position: AO
Credential:
Phone: 629-317-1465