Provider Demographics
NPI:1841225265
Name:ROMANS EIGHT TWENTY EIGHT
Entity Type:Organization
Organization Name:ROMANS EIGHT TWENTY EIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-861-4560
Mailing Address - Street 1:4223 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-1925
Mailing Address - Country:US
Mailing Address - Phone:303-961-4560
Mailing Address - Fax:303-477-5609
Practice Address - Street 1:4223 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-1925
Practice Address - Country:US
Practice Address - Phone:303-861-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4647410001332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4647410001Medicare NSC