Healthcare Provider Details

I. General information

NPI: 1891125217
Provider Name (Legal Business Name): AIM DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 EAGLERIDGE BLVD STE C
PUEBLO CO
81008-2329
US

IV. Provider business mailing address

1208 EAGLERIDGE BLVD STE C
PUEBLO CO
81008-2329
US

V. Phone/Fax

Practice location:
  • Phone: 719-246-7766
  • Fax:
Mailing address:
  • Phone: 719-246-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: ROBERT J AVILA
Title or Position: PRESIDENT
Credential: DC
Phone: 719-246-7766