Provider Demographics
NPI:1376054684
Name:PIKES PEAK MEDICAL SUPPLIES LTD
Entity Type:Organization
Organization Name:PIKES PEAK MEDICAL SUPPLIES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELL
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-313-9649
Mailing Address - Street 1:4942 DURASNO TER
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1229
Mailing Address - Country:US
Mailing Address - Phone:719-290-4379
Mailing Address - Fax:
Practice Address - Street 1:1352 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3314
Practice Address - Country:US
Practice Address - Phone:719-313-9649
Practice Address - Fax:719-313-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1376054684OtherNPI