Healthcare Provider Details

I. General information

NPI: 1114202041
Provider Name (Legal Business Name): STATESERV MEDICAL OF COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 FORD ST. SUITE A
COLORADO SPRINGS CO
80915
US

IV. Provider business mailing address

1201 S ALMA SCHOOL RD STE 4000
MESA AZ
85210-1148
US

V. Phone/Fax

Practice location:
  • Phone: 877-633-7250
  • Fax:
Mailing address:
  • Phone: 877-633-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: CHRIS ROODE
Title or Position: COO
Credential:
Phone: 480-797-8061