MEDICARE: IMAGING GROUP, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2085N0700X	Neuroradiology Physician
2	2085N0904X	Nuclear Radiology Physician
3	2085P0229X	Pediatric Radiology Physician
4	2085R0202X	Diagnostic Radiology Physician
5	2085U0001X	Diagnostic Ultrasound Physician
6	2085B0100X	Body Imaging Physician

General Provider Information

NPI Number	:	1619005048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGING GROUP, LLC

Provider Business Mailing Address
First Line	:	938 BANNOCK ST
Second Line	:	STE 300
City	:	DENVER
State	:	CO
Zip	:	80204-4028
Country	:	US
Telephone Number	:	303-914-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1499 W 120TH AVE
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-2751
Country	:	US
Telephone Number	:	303-280-8578
Fax Number	:

Authorized Official
Title or Position	:	BOARD MEMBER
Name	:	TRACY WALKER
Credential	:
Telephone Number	:	303-914-8800

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	02/01/2008

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