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NPI Code Detail

MEDICARE: PUEBLO RADIOLOGICAL GROUP PC

MEDICARE: PUEBLO RADIOLOGICAL GROUP PC
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
12085R0202XDiagnostic Radiology Physician
2261QR0200XRadiology 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
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568444271
Entity Type Code : Organization
Provider Name (Legal Business Name) : PUEBLO RADIOLOGICAL GROUP PC
Provider Business Mailing Address
First Line : PO BOX 7693
Second Line :
City : LOVELAND
State : CO
Zip : 80537-0693
Country : US
Telephone Number : 970-663-2742
Fax Number : 970-342-2093
Provider Business Practice Location Address
First Line : 1008 MINNEQUA AVE
Second Line :
City : PUEBLO
State : CO
Zip : 81004-3733
Country : US
Telephone Number : 719-584-7410
Fax Number : 719-542-7019
Authorized Official
Title or Position : AUTHORIZED REP/DIRECTOR
Name : MICHAEL J MCCOLLUM
Credential : MD
Telephone Number : 970-663-2742
Provider Enumeration Date : 11/17/2005
Last Update Date : 01/07/2026

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Directions to “PUEBLO RADIOLOGICAL GROUP PC ” Practice Location

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