NPIViewer - Provider NPI 1679513196

NPI:	1679513196
Name:	RADIOLOGY IMAGING ASSOCIATES, PC
Entity type:	Organization
Organization Name:	RADIOLOGY IMAGING ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:	GRACEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:	GRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	720-493-3716
Mailing Address - Street 1:	10800 E GEDDES AVE
Mailing Address - Street 2:
Mailing Address - City:	ENGLEWOOD
Mailing Address - State:	CO
Mailing Address - Zip Code:	80112-3894
Mailing Address - Country:	US
Mailing Address - Phone:	303-761-9190
Mailing Address - Fax:	720-874-4462
Practice Address - Street 1:	10800 E GEDDES AVE STE 300
Practice Address - Street 2:
Practice Address - City:	ENGLEWOOD
Practice Address - State:	CO
Practice Address - Zip Code:	80112-3895
Practice Address - Country:	US
Practice Address - Phone:	303-761-9190
Practice Address - Fax:	720-874-4462
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-06-07
Last Update Date:	2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization	Group
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology	Group - Single Specialty

State	Identifier ID	ID Type	Issuer
ID	1679513196	Medicaid
	201053620	Other	PRES SALUD MEDICAID
	CO1609	Other	HEALTHNET NE RIA
WY	107475000	Medicaid
AR	196643002	Medicaid
PA	000901750 0003	Medicaid
	8161045	Other	AETNA RIA
NM	G9020	Medicaid
IA	0560060	Medicaid
MT	1679513196	Medicaid
KS	100370940B	Medicaid
CO	4220042	Medicaid
TX	074088802	Medicaid
TN	1528962	Medicaid
AK	MPG0457	Medicaid
SC	QPB657	Medicaid
	RA22004	Other	BCBS RIA
AZ	695538	Medicaid
	CD2044	Other	RR MEDICARE RIA
IN	100006790A	Medicaid
AK	MPG0457	Medicaid
ID	1679513196	Medicaid
SC	QPB657	Medicaid
	CO1609	Other	HEALTHNET NE RIA
AR	196643002	Medicaid
NE	=========13	Medicaid
PA	000901750 0003	Medicaid