Provider Demographics
NPI:1306208756
Name:CTC MEDTEK LLC
Entity Type:Organization
Organization Name:CTC MEDTEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-353-4422
Mailing Address - Street 1:2121 MIDPOINT DR STE 208
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 MIDPOINT DR STE 208
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4341
Practice Address - Country:US
Practice Address - Phone:208-353-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies