PENRAD IMAGING LLC NPI 1003906868

NPI Information

NPI: 1003906868
Provider Name: PENRAD IMAGING LLC
Classification: Clinic/Center - 261QR0200X
Entity Type: Organization

Specialization: Radiology

CLIA Number: 06D1090669

Address:
3050 N CIRCLE DR
COLORADO SPRINGS, CO
ZIP 80909
Phone: (719) 785-9001
Get Directions

PENRAD IMAGING LLC is a radiology clinic center in Colorado Springs, CO. PENRAD IMAGING LLC NPI is 1003906868. The provider is registered as an organization entity type.

The provider's business location address is:

3050 N CIRCLE DR
COLORADO SPRINGS, CO
ZIP 80909-175
Phone: (719) 785-9001
Fax: (719) 867-7900

The provider's authorized official is Derek Scott Bergeson .
The authorized official title is Radiologist and has the following contact phone number (719) 593-1799.

The CLIA number assigned to this NPI record is 06D1090669 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/13/2006 and was last updated on 11/3/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0200X	Clinic/Center	Radiology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	04143046	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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