Healthcare Provider Details

I. General information

NPI: 1811923402
Provider Name (Legal Business Name): ROCKY MOUNTAIN MEDICAL IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MOUNTAIN VIEW AVE
LONGMONT CO
80501-3129
US

IV. Provider business mailing address

PO BOX 1157
LONGMONT CO
80502-1157
US

V. Phone/Fax

Practice location:
  • Phone: 303-651-5111
  • Fax:
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-667-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM B WAHL
Title or Position: OWNER
Credential: MD
Phone: 303-776-4824