MEDICARE: CTC MEDTEK LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1306208756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CTC MEDTEK LLC

Provider Business Mailing Address
First Line	:	2121 MIDPOINT DR STE 208
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 MIDPOINT DR STE 208
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4341
Country	:	US
Telephone Number	:	208-353-4422
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. KARI L GIBB
Credential	:
Telephone Number	:	208-353-4422

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	03/24/2016

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