Organization
PUEBLO IMAGING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LARAE ANN MILLER (CENTER MANAGER)
(719) 542-0172
Entity
Organization
Contact information
Practice address
404 W 12TH ST, PUEBLO, CO 81003-2815
(719) 542-0172
(719) 542-5072
Mailing address
404 W 12TH ST, PUEBLO, CO 81003-2815
(719) 542-0172
(719) 542-5072
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5047
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31789013
—
CO
Enumeration date
05/03/2006
Last updated
08/22/2020
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