Provider Demographics
NPI:1518963214
Name:SOUTH DENVER INTEGRATED IMAGING LLC
Entity Type:Organization
Organization Name:SOUTH DENVER INTEGRATED IMAGING LLC
Other - Org Name:DENVER INTEGRATED IMAGING SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-757-0332
Mailing Address - Street 1:99 INVERNESS DR E STE 110
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5122
Mailing Address - Country:US
Mailing Address - Phone:303-757-0332
Mailing Address - Fax:303-757-0558
Practice Address - Street 1:99 INVERNESS DR E STE 110
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5122
Practice Address - Country:US
Practice Address - Phone:303-757-0332
Practice Address - Fax:303-757-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18782078Medicaid