Healthcare Provider Details

I. General information

NPI: 1205597143
Provider Name (Legal Business Name): KOCO-PARA MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 BROOKSEDGE VW
COLORADO SPRINGS CO
80910-4455
US

IV. Provider business mailing address

2724 BROOKSEDGE VW
COLORADO SPRINGS CO
80910-4455
US

V. Phone/Fax

Practice location:
  • Phone: 303-257-7735
  • Fax:
Mailing address:
  • Phone: 303-257-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KOCA Z COLLINS
Title or Position: LAB DIRECTOR
Credential: RN
Phone: 303-257-7735