Provider Demographics
NPI:1992001622
Name:FRONT RANGE DMX
Entity Type:Organization
Organization Name:FRONT RANGE DMX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-938-9070
Mailing Address - Street 1:954 NORTH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3419
Mailing Address - Country:US
Mailing Address - Phone:303-938-9070
Mailing Address - Fax:303-938-9170
Practice Address - Street 1:954 NORTH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3419
Practice Address - Country:US
Practice Address - Phone:303-938-9070
Practice Address - Fax:303-938-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5016247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty