Provider Demographics
NPI:1366941171
Name:COAL CREEK DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:COAL CREEK DIAGNOSTICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRT
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:303-666-4151
Mailing Address - Street 1:315 W SOUTH BOULDER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1157
Mailing Address - Country:US
Mailing Address - Phone:303-666-4151
Mailing Address - Fax:303-666-4166
Practice Address - Street 1:315 W SOUTH BOULDER RD STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1157
Practice Address - Country:US
Practice Address - Phone:303-666-4151
Practice Address - Fax:303-666-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty