Healthcare Provider Details

I. General information

NPI: 1003461237
Provider Name (Legal Business Name): CAPITOL MEDICAL SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 LAKE PLAZA DR
COLORADO SPRINGS CO
80906-3506
US

IV. Provider business mailing address

1160 LAKE PLAZA DR
COLORADO SPRINGS CO
80906-3506
US

V. Phone/Fax

Practice location:
  • Phone: 719-208-7573
  • Fax: 202-667-1098
Mailing address:
  • Phone: 719-208-7573
  • Fax: 204-410-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: YIMAJ KALIFA
Title or Position: OWNER/ PRESIDENT
Credential:
Phone: 703-725-2240