Healthcare Provider Details

I. General information

NPI: 1639269988
Provider Name (Legal Business Name): FOCUSED ABLATION IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7170 SMOKE RANCH RD SUITE A
LAS VEGAS NV
89128-1103
US

IV. Provider business mailing address

1183 S HURON ST
DENVER CO
80223-3106
US

V. Phone/Fax

Practice location:
  • Phone: 303-810-5823
  • Fax: 303-698-4374
Mailing address:
  • Phone: 303-810-5823
  • Fax: 303-698-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICAH GAUTIER
Title or Position: ADMINISTRATOR
Credential:
Phone: 303-810-5823