Organization
RIA ENDOVASCULAR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACEANN GRILLO (CREDENTIALING SUPERVISOR)
(720) 493-3716
Entity
Organization
Contact information
Practice address
8200 E BELLEVIEW AVE, #600E, GREENWOOD VILLAGE, CO 80111
(720) 493-3406
(303) 643-4510
Mailing address
10800 E GEDDES AVE STE 300, ENGLEWOOD, CO 80112-3895
(303) 761-9190
(720) 874-4462
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30058082
—
CO
01
—
7655666
AETNA IVLC
—
01
—
DD7304
RR MEDICARE IVLC
—
Enumeration date
06/07/2006
Last updated
03/31/2024
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