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General NPI Number Information
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NPI Number | 1457375545
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Entity Type | Organization
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Legal Business Name | PROVISION IMAGING OF FT COLLINS
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4114 TIMBERLINE RD
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City | FORT COLLINS
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State | CO
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Zip | 80525-6034
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Country | US
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Telephone | 970-223-9939
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Fax | 970-223-0273
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Provider Business Mailing Address
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Address Line | 1601 NW EXPRESSWAY SUITE 1300
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City | OKLAHOMA CITY
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State | OK
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Zip | 73118
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Country | US
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Telephone | 405-842-7768
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Fax | 405-842-7789
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Authorized Official
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Title or Position | COO
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Name | MR. ROBERT MATT TRENT
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Credential |
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Telephone | 405-842-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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