MEDICARE: PHOENIX MEDICAL SUPPLY SPECIALISTS, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20201346609	OTHER	CO	COLORADO STATE

General Provider Information

NPI Number	:	1487275012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX MEDICAL SUPPLY SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	7950 E MISSISSIPPI AVE STE D
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-2151
Country	:	US
Telephone Number	:	303-747-7189
Fax Number	:	303-955-2397

Provider Business Practice Location Address
First Line	:	7950 E MISSISSIPPI AVE STE D
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80247-2151
Country	:	US
Telephone Number	:	303-747-7189
Fax Number	:	303-955-2397

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	LEONID REZNIKOV
Credential	:
Telephone Number	:	720-436-7613

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	07/06/2023

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