Provider Demographics
NPI:1992216261
Name:COMPASS PEAK IMAGING, LLC
Entity Type:Organization
Organization Name:COMPASS PEAK IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KULWIEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-945-7564
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0548
Mailing Address - Country:US
Mailing Address - Phone:970-945-7564
Mailing Address - Fax:844-684-4238
Practice Address - Street 1:120 MIDLAND AVE STE 260
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-9800
Practice Address - Country:US
Practice Address - Phone:970-665-2194
Practice Address - Fax:844-684-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology