Provider Demographics
NPI:1376603191
Name:PUEBLO BONE DENSITY CENTER
Entity Type:Organization
Organization Name:PUEBLO BONE DENSITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROUKEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-546-2229
Mailing Address - Street 1:4010 JERRY MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1045
Mailing Address - Country:US
Mailing Address - Phone:719-546-2229
Mailing Address - Fax:
Practice Address - Street 1:4010 JERRY MURPHY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1045
Practice Address - Country:US
Practice Address - Phone:719-546-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01281013Medicaid
COY13501Medicare UPIN
CO540498Medicare ID - Type Unspecified