Provider Demographics
NPI:1790730810
Name:PARKWEST IMAGING, L.L.C
Entity Type:Organization
Organization Name:PARKWEST IMAGING, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COOKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:719-542-2167
Mailing Address - Street 1:DEPT 1391
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-1391
Mailing Address - Country:US
Mailing Address - Phone:719-542-2167
Mailing Address - Fax:719-542-0320
Practice Address - Street 1:3676 PARKER BLVD SUITE 165
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2212
Practice Address - Country:US
Practice Address - Phone:719-595-7600
Practice Address - Fax:719-595-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91634237Medicaid
COC455838Medicare PIN
CO91634237Medicaid