Healthcare Provider Details

I. General information

NPI: 1417526237
Provider Name (Legal Business Name): COLORADO SPRINGS IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 RENAISSANCE TOWNE DR STE 107
BOUNTIFUL UT
84010-7667
US

IV. Provider business mailing address

8610 EXPLORER DR UNIT 300
COLORADO SPRINGS CO
80920-1036
US

V. Phone/Fax

Practice location:
  • Phone: 719-955-4332
  • Fax:
Mailing address:
  • Phone: 719-955-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANDREW BENSON
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 719-955-4332