Provider Demographics
NPI:1750344537
Name:RCOA IMAGING SERVICES, INC
Entity type:Organization
Organization Name:RCOA IMAGING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ACCOUNTING AND FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-477-3500
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0375
Mailing Address - Country:US
Mailing Address - Phone:866-293-3500
Mailing Address - Fax:866-293-3535
Practice Address - Street 1:1008 MINNEQUA AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3733
Practice Address - Country:US
Practice Address - Phone:866-293-3500
Practice Address - Fax:866-293-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1005-01261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO663825OtherANTHEM BCBS PROVIDER #
CO663825OtherANTHEM BCBS PROVIDER #