Healthcare Provider Details

I. General information

NPI: 1790857803
Provider Name (Legal Business Name): COLORADO PROFESSIONAL MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W SOUTH BOULDER RD STE 101
LAFAYETTE CO
80026-8910
US

IV. Provider business mailing address

1140 W S BOULDER RD SUITE 101
LAFAYETTE CO
80026-2854
US

V. Phone/Fax

Practice location:
  • Phone: 303-604-0682
  • Fax: 303-604-0684
Mailing address:
  • Phone: 303-232-2001
  • Fax: 303-233-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPENDING
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

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