Healthcare Provider Details

I. General information

NPI: 1386647543
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: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 W 2ND PL ST. ANTHONY MEDICAL PLAZA
LAKEWOOD CO
80228-1575
US

IV. Provider business mailing address

11750 W 2ND PL ST. ANTHONY MEDICAL PLAZA
LAKEWOOD CO
80228-1575
US

V. Phone/Fax

Practice location:
  • Phone: 303-233-2001
  • Fax: 303-233-6390
Mailing address:
  • Phone: 303-233-2001
  • Fax: 303-233-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number05-37672-0000
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number05-37672-0000
License Number StateCO

VIII. Authorized Official

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