Healthcare Provider Details

I. General information

NPI: 1528981438
Provider Name (Legal Business Name): PILOT KNOB MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOT 6 AVALON MESA
NORWOOD CO
81423
US

IV. Provider business mailing address

LOT 6 AVALON MESA
NORWOOD CO
81423
US

V. Phone/Fax

Practice location:
  • Phone: 307-640-8015
  • Fax:
Mailing address:
  • Phone: 307-640-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. TAYLOR HERMAN
Title or Position: OWNER
Credential:
Phone: 307-640-8015