Provider Demographics
NPI:1053341008
Name:GREELEY XRAY GROUP PC
Entity type:Organization
Organization Name:GREELEY XRAY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-381-8677
Mailing Address - Street 1:PO BOX 336940
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80633-0616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5890 W 13TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4821
Practice Address - Country:US
Practice Address - Phone:970-392-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG3008OtherBCBS
WY117621800Medicaid
CO04106084Medicaid
COG3008OtherBCBS
COC10608Medicare PIN