Provider Demographics
NPI:1679245799
Name:PROMED DME
Entity Type:Organization
Organization Name:PROMED DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-JUSTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-599-5753
Mailing Address - Street 1:3425 AUSTIN BLUFFS PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5724
Mailing Address - Country:US
Mailing Address - Phone:719-599-5753
Mailing Address - Fax:888-399-6476
Practice Address - Street 1:3425 AUSTIN BLUFFS PKWY STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5724
Practice Address - Country:US
Practice Address - Phone:719-599-5753
Practice Address - Fax:888-399-6476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies