Healthcare Provider Details

I. General information

NPI: 1376092890
Provider Name (Legal Business Name): HEALTHDYNE SPECIALTY COLORADO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 06/11/2025
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7472 S TUCSON WAY STE 100A
CENTENNIAL CO
80112-4452
US

IV. Provider business mailing address

500 EAGLES LANDING DR
LAKELAND FL
33810-2899
US

V. Phone/Fax

Practice location:
  • Phone: 800-641-8475
  • Fax:
Mailing address:
  • Phone: 888-479-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPDO1680000123
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP P BISESI
Title or Position: SENIOR VICE PRESIDENT & SECRETARY
Credential:
Phone: 863-583-6248