MEDICARE: BLOOM COLORADO 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1679346621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM COLORADO LLC

Provider Business Mailing Address
First Line	:	PO BOX 5943
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23471-0943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7130 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3185
Country	:	US
Telephone Number	:	719-762-1510
Fax Number	:	719-762-1520

Authorized Official
Title or Position	:	CEO
Name	:	SANDEEP PANDITTA
Credential	:
Telephone Number	:	719-762-1510

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	01/16/2026

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