Provider Demographics
NPI:1336188234
Name:MEDICAL IMAGING OF COLORADO
Entity Type:Organization
Organization Name:MEDICAL IMAGING OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-493-3716
Mailing Address - Street 1:10800 E GEDDES AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3894
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3895
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100370940AMedicaid
WY123484600Medicaid
18062OtherPRES SALUD MEDICAID MIC
CO4007803Medicaid
5797650OtherAETNA MIC
CO1190OtherHEALTHNET NE MIC
CC8768OtherRR MEDICARE MIC
MEW4008OtherBCBS MIC
TX074088801Medicaid
8489712601OtherPACIFICARE MIC
WY123484600Medicaid
MEW4008OtherBCBS MIC
NE=========00Medicaid