Provider Demographics
NPI:1417909235
Name:MRIGP INC
Entity Type:Organization
Organization Name:MRIGP INC
Other - Org Name:ADVANCED MEDICAL IMAGING
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-433-9729
Mailing Address - Street 1:2490 W 26TH AVE
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5314
Mailing Address - Country:US
Mailing Address - Phone:303-223-4441
Mailing Address - Fax:
Practice Address - Street 1:2490 W 26TH AVE
Practice Address - Street 2:SUITE 120A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5314
Practice Address - Country:US
Practice Address - Phone:303-223-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04005112Medicaid
CO4498777OtherAETNA
COCE1844OtherRAILROAD MEDICAID
CO842678OtherUNITED HEALTHCARE
COMR673162OtherANTHEM
CO842678OtherUNITED HEALTHCARE
CO4498777OtherAETNA