Provider Demographics
NPI:1609117225
Name:PLATTE VALLEY MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:PLATTE VALLEY MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:FANSELAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-498-3618
Mailing Address - Street 1:1606 PRAIRIE CENTER PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-498-3618
Mailing Address - Fax:303-498-3629
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY STE 130
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-498-3618
Practice Address - Fax:303-498-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology