Healthcare Provider Details

I. General information

NPI: 1366941171
Provider Name (Legal Business Name): COAL CREEK DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W SOUTH BOULDER RD STE 100
LOUISVILLE CO
80027-1157
US

IV. Provider business mailing address

315 W SOUTH BOULDER RD STE 100
LOUISVILLE CO
80027-1157
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-4151
  • Fax: 303-666-4166
Mailing address:
  • Phone: 303-666-4151
  • Fax: 303-666-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE BYRT
Title or Position: OWNER
Credential: MSPT
Phone: 303-666-4151