Provider Demographics
NPI:1538162581
Name:COLORADO OPEN IMAGING, LLC
Entity type:Organization
Organization Name:COLORADO OPEN IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-477-1815
Mailing Address - Street 1:1120 W SOUTH BOULDER RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8952
Mailing Address - Country:US
Mailing Address - Phone:303-926-5466
Mailing Address - Fax:303-926-5461
Practice Address - Street 1:1120 W SOUTH BOULDER RD
Practice Address - Street 2:STE 101
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8952
Practice Address - Country:US
Practice Address - Phone:303-926-5466
Practice Address - Fax:303-926-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89032047Medicaid
CO89032047Medicaid