Organization
OPEN MRI OF PUEBLO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS CHRISTENBERRY III (MANAGER)
(813) 284-2004
Entity
Organization
Contact information
Practice address
1425 B US HIGHWAY 50 WEST, PUEBLO, CO 81008-1686
(719) 404-0991
(719) 404-0997
Mailing address
1425 B US HIGHWAY 50 WEST, PUEBLO, CO 81008-1686
(719) 404-0991
(719) 404-0997
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81684339
—
CO
01
—
OP668242
BCBS
—
01
—
P00116808
RR MEDICARE
—
Enumeration date
09/29/2006
Last updated
05/19/2016
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