Provider Demographics
NPI:1427447614
Name:MOLECULAR IMAGING OF COLORADO LLC
Entity type:Organization
Organization Name:MOLECULAR IMAGING OF COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-838-2785
Mailing Address - Street 1:991 SOUTHPARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:991 SOUTHPARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5688
Practice Address - Country:US
Practice Address - Phone:303-954-4957
Practice Address - Fax:866-433-3965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CERESCAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-12
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46173207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Single Specialty