Provider Demographics
NPI:1659003200
Name:RADIANT HEALTHCARE LLC
Entity Type:Organization
Organization Name:RADIANT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-254-7421
Mailing Address - Street 1:1014 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:CO
Mailing Address - Zip Code:81067-1328
Mailing Address - Country:US
Mailing Address - Phone:719-254-7421
Mailing Address - Fax:
Practice Address - Street 1:1014 ELM AVE
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067-1328
Practice Address - Country:US
Practice Address - Phone:719-254-7421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty