Provider Demographics
NPI:1497265524
Name:EASE-E MEDICAL, INC.
Entity Type:Organization
Organization Name:EASE-E MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & DIR OF CUSTOMER CARE & BUSINES
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-276-1703
Mailing Address - Street 1:731 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4905
Mailing Address - Country:US
Mailing Address - Phone:719-276-1703
Mailing Address - Fax:719-276-1708
Practice Address - Street 1:2708 N 11TH ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-2714
Practice Address - Country:US
Practice Address - Phone:719-276-1703
Practice Address - Fax:719-276-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71277323Medicaid