NPIMap

Organization Active NPI

Pueblo Imaging Center, LLC

  • Specialist
  • Pueblo, CO
National Provider Identifier
1497713960
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
5047 Issued in CO
Legal business name
PUEBLO IMAGING CENTER, LLC
Practice address
404 W 12TH St
Pueblo, CO 81003-2815
Phone
(719) 542-0172
Fax
(719) 542-5072
NPI assigned
May 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Larae Ann Miller
Title
Center Manager
Phone
(719) 542-0172

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 5047 CO Primary

Addresses

Primary practice location

404 W 12TH St
Pueblo, CO 81003-2815

Mailing address

404 W 12TH St
Pueblo, CO 81003-2815
Phone (719) 542-0172

Other identifiers 1

IdentifierTypeStateIssuer
31789013MedicaidCO

National Provider Directory

National Provider Directory

Locations

404 W 12th St
Pueblo, CO 81003
Phone (719) 542-0172

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497713960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W 12TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032815",
            "telephone_number": "719-542-0172",
            "fax_number": "719-542-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W 12TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032815",
            "telephone_number": "719-542-0172",
            "fax_number": "719-542-5072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO IMAGING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "LARAE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CENTER MANAGER",
        "authorized_official_telephone_number": "719-542-0172",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CO",
            "license": "5047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31789013",
            "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.