Provider Demographics
NPI:1003849498
Name:FORT COLLINS RADIOLOGIC ASSOCIATES PC
Entity Type:Organization
Organization Name:FORT COLLINS RADIOLOGIC ASSOCIATES PC
Other - Org Name:ADVANCED MEDICAL IMAGING CONSULTANTS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-484-4757
Mailing Address - Street 1:2008 CARIBOU DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-484-4757
Mailing Address - Fax:970-484-4759
Practice Address - Street 1:2008 CARIBOU DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4325
Practice Address - Country:US
Practice Address - Phone:970-484-4757
Practice Address - Fax:970-377-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107532200Medicaid
CO04867040Medicaid
NE=========00Medicaid
WY107532200Medicaid
WYDE2230Medicare PIN
NECA6959Medicare PIN
COCS5250Medicare PIN
WY20478Medicare PIN
COC86704Medicare PIN