Provider Demographics
NPI:1639269988
Name:FOCUSED ABLATION IMAGING
Entity Type:Organization
Organization Name:FOCUSED ABLATION IMAGING
Other - Org Name:FOCUSED ABLATION IMAGING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-810-5823
Mailing Address - Street 1:1183 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-3106
Mailing Address - Country:US
Mailing Address - Phone:303-810-5823
Mailing Address - Fax:303-698-4374
Practice Address - Street 1:7170 SMOKE RANCH RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1103
Practice Address - Country:US
Practice Address - Phone:303-810-5823
Practice Address - Fax:303-698-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty