Provider Demographics
NPI:1609265933
Name:COLORADO MEDICAL CONSULTING, LLC
Entity Type:Organization
Organization Name:COLORADO MEDICAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-331-3929
Mailing Address - Street 1:445 E CHEYENNE MOUNTAIN BLVD
Mailing Address - Street 2:SUITE C416
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-1528
Mailing Address - Country:US
Mailing Address - Phone:719-331-3929
Mailing Address - Fax:719-473-4766
Practice Address - Street 1:445 E CHEYENNE MOUNTAIN BLVD
Practice Address - Street 2:SUITE C416
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-1528
Practice Address - Country:US
Practice Address - Phone:719-331-3929
Practice Address - Fax:719-473-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017823283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD23347Medicare UPIN