Provider Demographics
NPI:1518947399
Name:DIAGNOSTIC RADIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-644-4345
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-0308
Mailing Address - Country:US
Mailing Address - Phone:970-765-0818
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:2351 G RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-9641
Practice Address - Country:US
Practice Address - Phone:970-644-4345
Practice Address - Fax:970-644-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04032082Medicaid
CN2807OtherRAILROAD WORKERS MEDICARE
CO04032082Medicaid
CN2807OtherRAILROAD WORKERS MEDICARE