Provider Demographics
NPI:1386647543
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 1:11750 W 2ND PL
Mailing Address - Street 2:ST. ANTHONY MEDICAL PLAZA
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1575
Mailing Address - Country:US
Mailing Address - Phone:303-233-2001
Mailing Address - Fax:303-233-6390
Practice Address - Street 1:11750 W 2ND PL
Practice Address - Street 2:ST. ANTHONY MEDICAL PLAZA
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1575
Practice Address - Country:US
Practice Address - Phone:303-233-2001
Practice Address - Fax:303-233-6390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-23
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05-37672-0000332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57472335Medicaid
CO0316610001Medicare ID - Type Unspecified
CO57472335Medicaid