Provider Demographics
NPI:1013217769
Name:SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC
Entity Type:Organization
Organization Name:SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC
Other - Org Name:TRIDENTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-786-8015
Mailing Address - Street 1:930 RIDGEBROOK RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:800-786-8015
Mailing Address - Fax:443-662-4230
Practice Address - Street 1:11585 E 53RD AVE STE H
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-2321
Practice Address - Country:US
Practice Address - Phone:303-307-2028
Practice Address - Fax:303-576-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1013217769Medicaid
AZ095566Medicaid
LA2374656Medicaid
LA630001673OtherRAILROAD MEDICARE
CO9000189649Medicaid