Provider Demographics
NPI:1972509677
Name:NORTH DENVER INTEGRATED IMAGING LLC
Entity Type:Organization
Organization Name:NORTH DENVER INTEGRATED IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-252-4319
Mailing Address - Street 1:12520 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2406
Mailing Address - Country:US
Mailing Address - Phone:303-252-4363
Mailing Address - Fax:303-252-4319
Practice Address - Street 1:12520 GRANT DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2406
Practice Address - Country:US
Practice Address - Phone:303-252-4363
Practice Address - Fax:303-252-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98206273Medicaid
543958Medicare ID - Type Unspecified