Healthcare Provider Details

I. General information

NPI: 1780918466
Provider Name (Legal Business Name): LOCUST DURABLE MEDICAL EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 N 7TH ST STE A
GRAND JUNCTION CO
81501-8168
US

IV. Provider business mailing address

2352 N 7TH ST STE A
GRAND JUNCTION CO
81501-8168
US

V. Phone/Fax

Practice location:
  • Phone: 970-248-9834
  • Fax: 970-248-9835
Mailing address:
  • Phone: 970-248-9834
  • Fax: 970-248-9835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5257
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDR-39442
License Number StateCO

VIII. Authorized Official

Name: DR. CHRISTOPHER J ANGELLO
Title or Position: MANAGER
Credential: DC
Phone: 970-248-9834