MEDICARE: STATE OF COLORADO

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	251300000X	Local Education Agency (LEA)

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	:	1750427654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF COLORADO

Provider Business Mailing Address
First Line	:	33 N INSTITUTE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3508
Country	:	US
Telephone Number	:	719-578-2113
Fax Number	:	719-578-2239

Provider Business Practice Location Address
First Line	:	33 N INSTITUTE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3508
Country	:	US
Telephone Number	:	719-578-2113
Fax Number	:	719-578-2239

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. LARRY AKERS
Credential	:
Telephone Number	:	719-578-2113

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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Directions to “STATE OF COLORADO ” Practice Location

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