MEDICARE: CERESCAN CORP

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	261QR0200X	Radiology Clinic/Center	WN-M0304-1	WA

General Provider Information

NPI Number	:	1659603744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERESCAN CORP

Provider Business Mailing Address
First Line	:	990 S LOGAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4130
Country	:	US
Telephone Number	:	720-242-9081
Fax Number	:	866-433-3965

Provider Business Practice Location Address
First Line	:	1015 8TH AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-3504
Country	:	US
Telephone Number	:	720-242-9081
Fax Number	:	866-433-3965

Authorized Official
Title or Position	:	CEO
Name	:	JOHN KELLEY
Credential	:
Telephone Number	:	720-242-9081

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	02/01/2010

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