Provider Demographics
NPI:1043206311
Name:RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES
Other - Org Name:SOUTHERN COLORADO RADIOLOGISTS, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COOKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:719-542-2167
Mailing Address - Street 1:1619 N GREENWOOD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2644
Mailing Address - Country:US
Mailing Address - Phone:719-542-2167
Mailing Address - Fax:719-542-0320
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2644
Practice Address - Country:US
Practice Address - Phone:719-542-2167
Practice Address - Fax:719-542-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04756045Medicaid
CO04756045Medicaid