=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205597143
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOCO-PARA MEDICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2022
-----------------------------------------------------
Last Update Date | 01/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2724 BROOKSEDGE VW
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80910-4455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-257-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2724 BROOKSEDGE VW
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80910-4455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-257-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LAB DIRECTOR
-----------------------------------------------------
Name | KOCA Z COLLINS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 303-257-7735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------