Healthcare Provider Details

I. General information

NPI: 1467580720
Provider Name (Legal Business Name): HIGH PLAINS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 14TH ST
BURLINGTON CO
80807-1608
US

IV. Provider business mailing address

PO BOX 1809
GREELEY CO
80632-1809
US

V. Phone/Fax

Practice location:
  • Phone: 719-346-8851
  • Fax: 719-346-7302
Mailing address:
  • Phone: 970-353-3316
  • Fax: 970-353-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number150000003
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CJ SHOVLIN
Title or Position: MANAGER
Credential:
Phone: 970-353-3316