Provider Demographics
NPI:1154324168
Name:COLORADO PROFESSIONAL MEDICAL, INC
Entity Type:Organization
Organization Name:COLORADO PROFESSIONAL MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-493-8288
Mailing Address - Street 1:175 S UNION BLVD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3113
Mailing Address - Country:US
Mailing Address - Phone:303-232-2001
Mailing Address - Fax:303-233-6390
Practice Address - Street 1:175 S UNION BLVD
Practice Address - Street 2:STE 370
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3113
Practice Address - Country:US
Practice Address - Phone:719-632-5075
Practice Address - Fax:719-632-5078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER ORTHOPEDIC GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0537672-0003332B00000X
CO05-37672-0003335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57472335Medicaid
CO57472335Medicaid