| Organization Name: | PENRAD IMAGING LLC |
| NPI Number: | 1003906868 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOUGLAS L GIBSON (CEO) |
| Mailing Address: | 3050 N Circle Dr Colorado Springs |
| State: | CO US |
| Postal Code: | 809091175 |
| Phone Number: | 7197859001 |
| Fax Number: | 7198677900 |
| NPI Enumeration Date: | 10/13/2006 |
| NPI Last Update Date: | 10/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |