Provider Demographics
NPI:1104094119
Name:ASPEN DIAGNOSTICS & DECOMPRESSION
Entity type:Organization
Organization Name:ASPEN DIAGNOSTICS & DECOMPRESSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-384-4450
Mailing Address - Street 1:1517 BLAKE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3643
Mailing Address - Country:US
Mailing Address - Phone:970-384-4450
Mailing Address - Fax:970-947-9916
Practice Address - Street 1:24505 HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9204
Practice Address - Country:US
Practice Address - Phone:970-384-4450
Practice Address - Fax:970-947-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty