Provider Demographics
NPI:1407355670
Name:SCLTDI JV, LLC
Entity Type:Organization
Organization Name:SCLTDI JV, LLC
Other - Org Name:TOUCHSTONE IMAGING SUPERIOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-689-1691
Mailing Address - Street 1:PO BOX 746001
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 SUPERIOR DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8654
Practice Address - Country:US
Practice Address - Phone:720-378-5014
Practice Address - Fax:720-378-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory