Healthcare Provider Details

I. General information

NPI: 1154324168
Provider Name (Legal Business Name): COLORADO PROFESSIONAL MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD STE 370
COLORADO SPRINGS CO
80910-3113
US

IV. Provider business mailing address

175 S UNION BLVD SUITE 370
COLORADO SPRINGS CO
80910-3113
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-5075
  • Fax: 719-632-5078
Mailing address:
  • Phone: 303-232-2001
  • Fax: 303-233-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0537672-0003
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number05-37672-0003
License Number StateCO

VIII. Authorized Official

Name: SHERYL S PRICE
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 503-493-8288