MEDICARE: COLORADO PROFESSIONAL MEDICAL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier
2	332BC3200X	Customized Equipment (DME)	PENDING	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790857803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO PROFESSIONAL MEDICAL, INC

Provider Business Mailing Address
First Line	:	1140 W S BOULDER RD
Second Line	:	SUITE 101
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2854
Country	:	US
Telephone Number	:	303-232-2001
Fax Number	:	303-233-6390

Provider Business Practice Location Address
First Line	:	1140 W SOUTH BOULDER RD STE 101
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8910
Country	:	US
Telephone Number	:	303-604-0682
Fax Number	:	303-604-0684

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	SHERYL S PRICE
Credential	:
Telephone Number	:	503-493-8288

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	02/09/2011

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