Provider Demographics
NPI:1073558474
Name:COLORADO DIAGNOSTIC MEDICINE, LLC
Entity Type:Organization
Organization Name:COLORADO DIAGNOSTIC MEDICINE, LLC
Other - Org Name:WADSWORTH OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-839-9901
Mailing Address - Street 1:4374 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:314-839-9901
Mailing Address - Fax:314-839-9902
Practice Address - Street 1:5920 S ESTES ST
Practice Address - Street 2:STE. 150
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-8618
Practice Address - Country:US
Practice Address - Phone:303-948-5765
Practice Address - Fax:303-948-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804712Medicare ID - Type Unspecified