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
4925 N NEVADA AVE, COLORADO SPRINGS, CO 80918-8600
(719) 593-1799
(719) 265-3794
Mailing address
1390 KELLY JOHNSON BLVD, COLORADO SPRINGS, CO 80920-3908
(719) 593-1799
(719) 265-3794
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
05/11/2020
Last updated
05/11/2020
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