Provider Demographics
NPI:1194818807
Name:SILT IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:SILT IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-945-6535
Mailing Address - Street 1:2001 N HORSESHOE TRL
Mailing Address - Street 2:
Mailing Address - City:SILT
Mailing Address - State:CO
Mailing Address - Zip Code:81652-9832
Mailing Address - Country:US
Mailing Address - Phone:970-876-5700
Mailing Address - Fax:970-876-0482
Practice Address - Street 1:2001 HORSESHOE TRAIL
Practice Address - Street 2:
Practice Address - City:SILT
Practice Address - State:CO
Practice Address - Zip Code:81652
Practice Address - Country:US
Practice Address - Phone:970-876-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC554698Medicare ID - Type Unspecified