Healthcare Provider Details

I. General information

NPI: 1194818807
Provider Name (Legal Business Name): SILT IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 HORSESHOE TRAIL
SILT CO
81652
US

IV. Provider business mailing address

2001 N HORSESHOE TRL
SILT CO
81652-9832
US

V. Phone/Fax

Practice location:
  • Phone: 970-876-5700
  • Fax:
Mailing address:
  • Phone: 970-876-5700
  • Fax: 970-876-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. LARRY L DUPPER
Title or Position: CFO
Credential:
Phone: 970-945-6535