Provider Demographics
NPI:1679811582
Name:BROOMFIELD DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:BROOMFIELD DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-635-2225
Mailing Address - Street 1:6363 W 120TH AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-0300
Mailing Address - Country:US
Mailing Address - Phone:303-635-2225
Mailing Address - Fax:303-635-1078
Practice Address - Street 1:6363 W 120TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-0300
Practice Address - Country:US
Practice Address - Phone:303-635-2225
Practice Address - Fax:303-635-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41654021Medicaid
COC536988Medicare UPIN