MEDICARE: MOUNTAIN RADIOLOGY, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2085R0204X	Vascular & Interventional Radiology Physician
2	2086S0129X	Vascular Surgery Physician
3	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1245825744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN RADIOLOGY, INC

Provider Business Mailing Address
First Line	:	PO BOX 85500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5500
Country	:	US
Telephone Number	:	970-900-6856
Fax Number	:

Provider Business Practice Location Address
First Line	:	18426 W WILLOW OAK BEND DR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-2781
Country	:	US
Telephone Number	:	970-945-7564
Fax Number	:

Authorized Official
Title or Position	:	AO
Name	:	KAREN MARIE VAUGHN
Credential	:
Telephone Number	:	629-317-1465

Provider Enumeration Date	:	03/05/2021
Last Update Date	:	03/26/2026

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Directions to “MOUNTAIN RADIOLOGY, INC ” Practice Location

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