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NPI Code Detail

MEDICARE: CHERRY CREEK IMAGING, LLC

MEDICARE: CHERRY CREEK IMAGING, LLC
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
1261QR0200XRadiology Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2C554478OTHERCOTRAILBLAZER MEDICAR

General Provider Information

NPI Number : 1154357788
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHERRY CREEK IMAGING, LLC
Provider Business Mailing Address
First Line : P.O. BOX 809
Second Line :
City : DENVER
State : CO
Zip : 80206-0809
Country : US
Telephone Number : 303-468-1395
Fax Number : 303-355-7865
Provider Business Practice Location Address
First Line : 12687 W CEDAR DR
Second Line : SUITE 200
City : LAKEWOOD
State : CO
Zip : 80228-2010
Country : US
Telephone Number : 303-355-4674
Fax Number : 303-355-7865
Authorized Official
Title or Position : PRESIDENT
Name : MR. ROBERT P. ALLEN
Credential : M.D.
Telephone Number : 303-355-4674
Provider Enumeration Date : 06/24/2006
Last Update Date : 12/13/2011

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