Healthcare Provider Details

I. General information

NPI: 1154357788
Provider Name (Legal Business Name): CHERRY CREEK IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12687 W CEDAR DR SUITE 200
LAKEWOOD CO
80228-2010
US

IV. Provider business mailing address

P.O. BOX 809
DENVER CO
80206-0809
US

V. Phone/Fax

Practice location:
  • Phone: 303-355-4674
  • Fax: 303-355-7865
Mailing address:
  • Phone: 303-468-1395
  • Fax: 303-355-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT P. ALLEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 303-355-4674