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General NPI Number Information
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NPI Number | 1881620342
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Entity Type | Organization
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Legal Business Name | TWIN PEAKS MEDICAL IMAGING LLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 1950 MOUNTAIN VIEW AVE
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City | LONGMONT
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State | CO
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Zip | 80501-3129
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Country | US
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Telephone | 720-494-4777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 87
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City | LONGMONT
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State | CO
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Zip | 80502-0087
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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 | PRESIDENT
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Name | DR. WILLIAM B WAHL
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Credential | MD
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Telephone | 877-662-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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