1376698696 NPI number — COLUMBINE MEDICAL EQUIPMENT INC

Table of content: (NPI 1376698696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376698696 NPI number — COLUMBINE MEDICAL EQUIPMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBINE MEDICAL EQUIPMENT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376698696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
802 W DRAKE RD
Provider Second Line Business Mailing Address:
STE 123
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80526-5567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-221-1453
Provider Business Mailing Address Fax Number:
970-490-2754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 W DRAKE RD
Provider Second Line Business Practice Location Address:
STE 123
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80526-5567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-221-1453
Provider Business Practice Location Address Fax Number:
970-490-2754
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FANCHER
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
970-482-0198

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  15130380000 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08003634 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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