Healthcare Provider Details

I. General information

NPI: 1356852214
Provider Name (Legal Business Name): BIOEMULATION LAB AND IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 PINE GROVE RD
STEAMBOAT SPRINGS CO
80487-8803
US

IV. Provider business mailing address

1475 PINE GROVE RD
STEAMBOAT SPRINGS CO
80487-8803
US

V. Phone/Fax

Practice location:
  • Phone: 720-289-7001
  • Fax:
Mailing address:
  • Phone: 720-289-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ANDREW T JORGENSEN
Title or Position: OWNER
Credential: DMD
Phone: 720-289-7001