Provider Demographics
NPI:1801832779
Name:LYONS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:LYONS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-307-4621
Mailing Address - Street 1:2349 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5341
Mailing Address - Country:US
Mailing Address - Phone:303-307-4621
Mailing Address - Fax:720-394-2365
Practice Address - Street 1:3425 E 28TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5025
Practice Address - Country:US
Practice Address - Phone:303-307-4621
Practice Address - Fax:720-394-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04179269Medicaid
CO4629920001Medicare ID - Type Unspecified