Organization
PUEBLO RADIOLOGICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J MCCOLLUM MD (AUTHORIZED REP/DIRECTOR)
(970) 663-2742
Entity
Organization
Contact information
Practice address
1008 MINNEQUA AVE, PUEBLO, CO 81004-3733
(719) 584-7410
(719) 542-7019
Mailing address
PO BOX 7693, LOVELAND, CO 80537-0693
(970) 663-2742
(970) 342-2093
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04870085
—
CO
Enumeration date
11/17/2005
Last updated
01/07/2026
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