Provider Demographics
NPI:1376698696
Name:COLUMBINE MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:COLUMBINE MEDICAL EQUIPMENT INC
Other - Org Name:MARKET CENTRE MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-482-0198
Mailing Address - Street 1:802 W DRAKE RD
Mailing Address - Street 2:STE 123
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5567
Mailing Address - Country:US
Mailing Address - Phone:970-221-1453
Mailing Address - Fax:970-490-2754
Practice Address - Street 1:802 W DRAKE RD
Practice Address - Street 2:STE 123
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5567
Practice Address - Country:US
Practice Address - Phone:970-221-1453
Practice Address - Fax:970-490-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15130380000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08003634Medicaid
CO08003634Medicaid