Provider Demographics
NPI:1659603744
Name:CERESCAN CORP
Entity Type:Organization
Organization Name:CERESCAN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-242-9081
Mailing Address - Street 1:990 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4130
Mailing Address - Country:US
Mailing Address - Phone:720-242-9081
Mailing Address - Fax:866-433-3965
Practice Address - Street 1:1015 8TH AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3504
Practice Address - Country:US
Practice Address - Phone:720-242-9081
Practice Address - Fax:866-433-3965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CERESCAN CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWN-M0304-1261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology