Healthcare Provider Details

I. General information

NPI: 1205923596
Provider Name (Legal Business Name): DIVERSIFIED RADIOLOGY OF COLORADO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 COLE BLVD SUITE 150
LAKEWOOD CO
80401-3208
US

IV. Provider business mailing address

1746 COLE BLVD SUITE 150
LAKEWOOD CO
80401-3208
US

V. Phone/Fax

Practice location:
  • Phone: 303-914-8800
  • Fax: 303-716-3777
Mailing address:
  • Phone: 303-914-8800
  • Fax: 303-716-3777

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: TRACY L. WALKER
Title or Position: CFO
Credential:
Phone: 303-914-8800