Provider Demographics
NPI:1285689596
Name:DIAGNOSTIC IMAGING OF COLORADO SPRINGS LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING OF COLORADO SPRINGS LLC
Other - Org Name:NORTH POWERS MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-596-5185
Mailing Address - Street 1:PO BOX 21820
Mailing Address - Street 2:DEPT 1425
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1820
Mailing Address - Country:US
Mailing Address - Phone:918-745-2299
Mailing Address - Fax:
Practice Address - Street 1:6140 TUTT BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3575
Practice Address - Country:US
Practice Address - Phone:719-380-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804638Medicare PIN