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General NPI Number Information
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NPI Number | 1306901129
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Entity Type | Organization
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Legal Business Name | COLORADO SPRINGS SURGICAL & SUPPLY CO, INC.
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1833 N CIRCLE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-2410
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Country | US
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Telephone | 719-632-4036
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Fax | 719-632-8172
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Provider Business Mailing Address
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Address Line | 1833 N CIRCLE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-2410
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Country | US
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Telephone | 719-632-4036
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Fax | 719-632-8172
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GREGORY JOHN FRIES
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Credential |
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Telephone | 719-632-4036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 08732170000
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License Number State | CO
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