Healthcare Provider Details

I. General information

NPI: 1912801549
Provider Name (Legal Business Name): PURE INFUSION OF COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 FORTINO BLVD STE C
PUEBLO CO
81008-2032
US

IV. Provider business mailing address

75 W TOWNE RIDGE PKWY TOWER 2 STE 500
SANDY UT
84070-5522
US

V. Phone/Fax

Practice location:
  • Phone: 801-590-9267
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: SCOTT FRIEDMAN
Title or Position: COO
Credential:
Phone: 914-589-8866