Provider Demographics
NPI:1952673410
Name:COLORADO ELECTRODIAGNOSTIC SERVICES, LLC
Entity Type:Organization
Organization Name:COLORADO ELECTRODIAGNOSTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-988-7801
Mailing Address - Street 1:6825 S GALENA ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3715
Mailing Address - Country:US
Mailing Address - Phone:720-988-7801
Mailing Address - Fax:303-790-2445
Practice Address - Street 1:6825 S GALENA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3715
Practice Address - Country:US
Practice Address - Phone:720-988-7801
Practice Address - Fax:303-790-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty