Basic Information
| Provider Information | |||||||||
| NPI: | 1821294695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COURSEY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 2085R0202X | 12300 | ND | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 12300 | ND | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | 59353 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 601958ZLJ3 | 01 | CO | MEDICARE PIN | OTHER | 9000153041 | 05 | CO | MEDICAID | NA1214124 | 01 | NE | MEDICARE PIN | OTHER | NA1215125 | 01 | NE | MEDICARE PIN | OTHER | 601958ZNTB | 01 | CO | MEDICARE PIN | OTHER | NA2517102 | 01 | NE | MEDICARE PIN | OTHER | 111257112 | 01 | KS | MEDICARE PIN | OTHER | 601958YQ33 | 01 | CO | MEDICARE PIN | OTHER | 16893 | 05 | ND | MEDICAID | 601958YQ3L | 01 | CO | MEDICARE PIN | OTHER | 601958YQN9 | 01 | CO | MEDICARE PIN | OTHER | 601958YQPG | 01 | CO | MEDICARE PIN | OTHER | KA3249103 | 01 | KS | MEDICARE PIN | OTHER |