Provider Demographics
NPI:1174711147
Name:DRY CREEK IMAGING, LLC
Entity type:Organization
Organization Name:DRY CREEK IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:615-661-9200
Mailing Address - Street 1:PO BOX 116037
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6037
Mailing Address - Country:US
Mailing Address - Phone:615-661-9200
Mailing Address - Fax:615-661-9297
Practice Address - Street 1:14062 DENVER WEST PKWY
Practice Address - Street 2:STE 180 BLDG 52
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3187
Practice Address - Country:US
Practice Address - Phone:303-216-9000
Practice Address - Fax:303-216-2101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOUCHSTONE MEDICAL IMAGING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-04
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO810588Medicare PIN