Provider Demographics
NPI:1003587692
Name:ELEVATION MEDICAL IMAGING GILLETTE
Entity Type:Organization
Organization Name:ELEVATION MEDICAL IMAGING GILLETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRIKOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-682-1779
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80034-0736
Mailing Address - Country:US
Mailing Address - Phone:307-218-8223
Mailing Address - Fax:317-218-8224
Practice Address - Street 1:913 E BOXELDER RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718
Practice Address - Country:US
Practice Address - Phone:307-682-1779
Practice Address - Fax:307-682-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology