MEDICARE: COLORADO LAB TESTING 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	:	1952256091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO LAB TESTING LLC

Provider Business Mailing Address
First Line	:	2020 N ACADEMY BLVD STE 270
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 N ACADEMY BLVD STE 270
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1567
Country	:	US
Telephone Number	:	682-439-5392
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	MASTANI SHAIK
Credential	:
Telephone Number	:	682-439-5392

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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