Provider Demographics
NPI:1386683340
Name:SUBSPECIALTY IMAGING PARTNERS PROF, LLC
Entity Type:Organization
Organization Name:SUBSPECIALTY IMAGING PARTNERS PROF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-761-9190
Mailing Address - Street 1:PO BOX 3079
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80155-3079
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:303-761-6322
Practice Address - Street 1:10700 E GEDDES AVE
Practice Address - Street 2:#200
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3800
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:303-761-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66638739Medicaid
CO66638739Medicaid