Healthcare Provider Details

I. General information

NPI: 1457354326
Provider Name (Legal Business Name): COLORADO PROFESSIONAL MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE SUITE 245
DENVER CO
80210-5073
US

IV. Provider business mailing address

850 E HARVARD AVE SUITE 245
DENVER CO
80210-5073
US

V. Phone/Fax

Practice location:
  • Phone: 303-996-0686
  • Fax: 303-996-0688
Mailing address:
  • Phone: 303-996-0686
  • Fax: 303-996-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number18-17166-0000
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number18-17166-0000
License Number StateCO

VIII. Authorized Official

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