Provider Demographics
NPI:1235202524
Name:CLOUD CITY MEDICAL INC
Entity Type:Organization
Organization Name:CLOUD CITY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DORCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-566-1674
Mailing Address - Street 1:PO BOX 550309
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-0309
Mailing Address - Country:US
Mailing Address - Phone:205-566-1674
Mailing Address - Fax:205-278-6900
Practice Address - Street 1:331 US HWY 24 SOUTH
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461
Practice Address - Country:US
Practice Address - Phone:719-486-2950
Practice Address - Fax:719-486-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO07-68873-0000332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96459743Medicaid
CO5835790001Medicare NSC