NPIMap

Organization Active NPI

Southern Colorado Radiologists, P.C.

  • Specialist
  • Pueblo, CO
National Provider Identifier
1386699486
Registry record updated Apr 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTHERN COLORADO RADIOLOGISTS, P.C.
Practice address
1619 N Greenwood St Ste 103
Pueblo, CO 81003-2655
Phone
(719) 542-2167
Fax
(719) 542-0320
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cookie Henderson, R.T.
Title
Office Manager
Phone
(719) 542-2167

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

1619 N Greenwood St Ste 103
Pueblo, CO 81003-2655

Mailing address

PO Box 11512
Pueblo, CO 81001-0512
Phone (719) 542-2167

Other identifiers 1

IdentifierTypeStateIssuer
04117081MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040330001136 CO Part B Supplier - Clinic/Group Practice 7517959794 Receives reassigned benefits from 11 practitioners
Practice locations: Pueblo, CO

National Provider Directory

National Provider Directory

Locations

1619 N Greenwood St
Ste 103
Pueblo, CO 81003
Phone (719) 542-2167

1619 N Greenwood St
Ste 100
Pueblo, CO 81003
Phone (719) 542-2167

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1386699486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11512",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810010512",
            "telephone_number": "719-542-2167",
            "fax_number": "719-542-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 N GREENWOOD ST STE 103",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032655",
            "telephone_number": "719-542-2167",
            "fax_number": "719-542-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COLORADO RADIOLOGISTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "COOKIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "719-542-2167",
        "authorized_official_credential": "R.T."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04117081",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.