MEDICARE: COLORADO PROFESSIONAL MEDICAL, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	05-37672-0003	CO
2	332B00000X	Durable Medical Equipment & Medical Supplies	0537672-0003	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154324168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO PROFESSIONAL MEDICAL, INC

Provider Business Mailing Address
First Line	:	175 S UNION BLVD
Second Line	:	SUITE 370
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3113
Country	:	US
Telephone Number	:	303-232-2001
Fax Number	:	303-233-6390

Provider Business Practice Location Address
First Line	:	175 S UNION BLVD
Second Line	:	STE 370
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3113
Country	:	US
Telephone Number	:	719-632-5075
Fax Number	:	719-632-5078

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	SHERYL S PRICE
Credential	:
Telephone Number	:	503-493-8288

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/15/2008

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Directions to “COLORADO PROFESSIONAL MEDICAL, INC ” Practice Location

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