Provider Demographics
NPI:1700034360
Name:TJ ENTPZ OF COLO INC
Entity Type:Organization
Organization Name:TJ ENTPZ OF COLO INC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:303-987-1222
Mailing Address - Street 1:7978 W ALAMEDA AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3086
Mailing Address - Country:US
Mailing Address - Phone:303-987-1222
Mailing Address - Fax:303-987-1331
Practice Address - Street 1:7978 W ALAMEDA AVE
Practice Address - Street 2:UNIT D
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3086
Practice Address - Country:US
Practice Address - Phone:303-987-1222
Practice Address - Fax:303-987-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5326830001Medicare NSC