Basic Information
| Provider Information | |||||||||
| NPI: | 1255306726 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO IMAGING ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 DENVER WEST DRIVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034161360 | ||||||||
| FaxNumber: | 3034161058 | ||||||||
| Practice Location | |||||||||
| Address1: | 11600 WEST 2ND PLACE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203210000 | ||||||||
| FaxNumber: | 7203211621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | WOOLLEY | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 3034161360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 04987046 | 05 | CO | MEDICAID | CC7308 | 01 | CO | RRB | OTHER | CC7308 | 01 | CO | RAILROAD MEDICARE | OTHER |