Provider Demographics
NPI:1396851234
Name:RED MOUNTAIN RADIOLOGY PROFESSIONAL LLC
Entity Type:Organization
Organization Name:RED MOUNTAIN RADIOLOGY PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-275-0966
Mailing Address - Street 1:831 ROYAL GORGE BLVD
Mailing Address - Street 2:SUITE 422
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212
Mailing Address - Country:US
Mailing Address - Phone:719-275-0966
Mailing Address - Fax:719-275-2703
Practice Address - Street 1:1338 PHAY AVE
Practice Address - Street 2:ST THOMAS MORE HOSPITAL
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212
Practice Address - Country:US
Practice Address - Phone:719-285-2036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04016416Medicaid
COCE7950OtherRAILROAD MEDICARE
CO04016416Medicaid