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General NPI Number Information
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NPI Number | 1437493848
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Entity Type | Organization
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Legal Business Name | PINE CREEK IMAGING, LLC
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 9480 BRIAR VILLAGE PT STE 300
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7923
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Country | US
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Telephone | 719-599-0670
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Fax |
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Provider Business Mailing Address
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Address Line | 9480 BRIAR VILLAGE PT., SUITE 300
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LL PICKLE
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Credential |
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Telephone | 719-599-0670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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