=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003461237
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPITOL MEDICAL SUPPLY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2019
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1160 LAKE PLAZA DR
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80906-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-208-7573
-----------------------------------------------------
Fax | 202-667-1098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1160 LAKE PLAZA DR
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80906-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-208-7573
-----------------------------------------------------
Fax | 204-410-2597
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PRESIDENT
-----------------------------------------------------
Name | YIMAJ KALIFA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-725-2240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------