Provider Demographics
NPI:1659477719
Name:BLACK DIAMOND INVESTMENTS LLC
Entity Type:Organization
Organization Name:BLACK DIAMOND INVESTMENTS LLC
Other - Org Name:COLUMBINE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-663-4600
Mailing Address - Street 1:3515 MOUNTAIN LION DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-8819
Mailing Address - Country:US
Mailing Address - Phone:970-663-4600
Mailing Address - Fax:970-663-7478
Practice Address - Street 1:3515 MOUNTAIN LION DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-8819
Practice Address - Country:US
Practice Address - Phone:970-663-4600
Practice Address - Fax:970-663-7478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
CO8200000063336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000160528Medicaid
2001124OtherPK
0188310001Medicare NSC