Provider Demographics
NPI:1437263811
Name:ROCKY MOUNTAIN DIAGNOSTIC IMAGING, P.C.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN DIAGNOSTIC IMAGING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SHEYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-240-6924
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-0580
Mailing Address - Country:US
Mailing Address - Phone:970-240-6924
Mailing Address - Fax:970-240-7903
Practice Address - Street 1:231 S NEVADA AVE STE B
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4233
Practice Address - Country:US
Practice Address - Phone:970-240-6924
Practice Address - Fax:970-240-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
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
CO04007712Medicaid
COROC2708OtherBCBS CO. GROUP NUMBER
CO1440052OtherUNITED MINE WORKERS
COROC2708OtherBCBS CO. GROUP NUMBER
COCS6779Medicare ID - Type UnspecifiedRR MEDICARE GROUP NUMBER