Organization
POUDRE VALLEY OPEN MRI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL P BELICK (C.E.O.)
(415) 884-3096
Entity
Organization
Contact information
Practice address
2420 E PROSPECT RD, FORT COLLINS, CO 80525-9729
(970) 493-0567
Mailing address
PO BOX 6102, NOVATO, CA 94948-6102
(415) 884-3418
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
CO
261QR0200X
Radiology Clinic/Center
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81833237
—
CO
01
—
P00080903
RAILROAD MEDICARE
CO
Enumeration date
05/27/2006
Last updated
07/14/2008
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