Provider Demographics
NPI:1568086569
Name:COLORADO MEDICAL SUPPLY
Entity Type:Organization
Organization Name:COLORADO MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GROELZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-378-6935
Mailing Address - Street 1:413 SUMMIT BLVD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8295
Mailing Address - Country:US
Mailing Address - Phone:303-499-6565
Mailing Address - Fax:303-499-8585
Practice Address - Street 1:413 SUMMIT BLVD UNIT 101
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8295
Practice Address - Country:US
Practice Address - Phone:303-499-6565
Practice Address - Fax:303-499-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies