Basic Information
| Provider Information | |||||||||
| NPI: | 1407821960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRENGER | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E. GEDDES AVE SUITE 200 | ||||||||
| Address2: | ATTN CREDENTIALING | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 3037616278 | ||||||||
| Practice Location | |||||||||
| Address1: | 10700 E. GEDDES AVE SUITE 200 | ||||||||
| Address2: | ATTN CREDENTIALING | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 3037616278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 09/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 3484 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 3484 | AZ | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 32827 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 84059792913 | 05 | NE | MEDICAID | 1Z7046 | 01 | AZ | HEALTH NET OF AZ | OTHER | 01328277 | 05 | CO | MEDICAID | 84089712600 | 05 | NE | MEDICAID | AZ0861410 | 01 | AZ | BCBSAZ | OTHER | XPY193671 | 01 | AZ | MEDI-CAL MEDICAID | OTHER | 481846 | 05 | AZ | MEDICAID |