Provider Demographics
NPI:1629829098
Name:COLORADO ADVANCED ENDOVASCULAR, LLC
Entity type:Organization
Organization Name:COLORADO ADVANCED ENDOVASCULAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-669-3036
Mailing Address - Street 1:7375 W 52ND AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-3748
Mailing Address - Country:US
Mailing Address - Phone:303-223-4448
Mailing Address - Fax:720-501-5199
Practice Address - Street 1:355 UNION BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-6516
Practice Address - Country:US
Practice Address - Phone:720-669-3036
Practice Address - Fax:720-545-1584
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO IMAGING ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty