Provider Demographics
NPI:1730634882
Name:COLORADO SPRINGS IMAGING LLC
Entity Type:Organization
Organization Name:COLORADO SPRINGS IMAGING LLC
Other - Org Name:COLORADO SPRINGS IMAGING AT BRIARGATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF REVENUE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-884-4077
Mailing Address - Street 1:8610 EXPLORER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1058
Mailing Address - Country:US
Mailing Address - Phone:719-955-4332
Mailing Address - Fax:719-955-4148
Practice Address - Street 1:2430 RESEARCH PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1093
Practice Address - Country:US
Practice Address - Phone:719-955-4332
Practice Address - Fax:719-955-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty