Healthcare Provider Details

I. General information

NPI: 1104082221
Provider Name (Legal Business Name): SCHRYVER MEDICAL SALES AND MARKETING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 S ORCHARD ST 105
BOISE ID
83705-3793
US

IV. Provider business mailing address

12075 E 45TH AVE SUITE 600
DENVER CO
80239-3136
US

V. Phone/Fax

Practice location:
  • Phone: 303-371-0073
  • Fax: 303-785-9283
Mailing address:
  • Phone: 303-371-0073
  • Fax: 303-785-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberC 179257
License Number StateID

VIII. Authorized Official

Name: DOUG R GOETZ
Title or Position: CEO
Credential:
Phone: 303-371-0073