Organization
PENRAD IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK SCOTT BERGESON MD (RADIOLOGIST)
(719) 593-1799
Entity
Organization
Contact information
Practice address
3050 N CIRCLE DR, COLORADO SPRINGS, CO 80909-1175
(719) 785-9001
(719) 867-7900
Mailing address
PO BOX 2989, COLORADO SPRINGS, CO 80901-2989
(719) 593-1799
(719) 265-3794
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04143046
—
CO
Enumeration date
10/13/2006
Last updated
11/03/2020
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