MEDICARE: SOUTHWEST DIAGNOSTIC CENTERS OF COLORADO SPRINGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033164991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST DIAGNOSTIC CENTERS OF COLORADO SPRINGS

Provider Business Mailing Address
First Line	:	2020 NORTH ACADEMY BLVD
Second Line	:	SUITE 155
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:	719-380-7210
Fax Number	:	719-380-7510

Provider Business Practice Location Address
First Line	:	2020 N ACADEMY BLVD
Second Line	:	SUITE 155
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:	719-380-7210
Fax Number	:	719-380-7510

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	JANICE BENNETT
Credential	:
Telephone Number	:	719-380-7210

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	12/06/2011

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