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	18-17166-0000	CO
2	332B00000X	Durable Medical Equipment & Medical Supplies	18-17166-0000	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	:	1457354326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO PROFESSIONAL MEDICAL, INC.

Provider Business Mailing Address
First Line	:	850 E HARVARD AVE
Second Line	:	SUITE 245
City	:	DENVER
State	:	CO
Zip	:	80210-5073
Country	:	US
Telephone Number	:	303-996-0686
Fax Number	:	303-996-0688

Provider Business Practice Location Address
First Line	:	850 E HARVARD AVE
Second Line	:	SUITE 245
City	:	DENVER
State	:	CO
Zip	:	80210-5073
Country	:	US
Telephone Number	:	303-996-0686
Fax Number	:	303-996-0688

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/07/2013

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